title: Laparoscopic Roux-en-Y gastric bypass: differences in outcome between attendings and assistants of different training backgrounds.
abstract: BACKGROUND
  Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is associated with a significant learning curve. We hypothesize that differences in surgeon and assistant training backgrounds may significantly impact outcomes during the learning curve.
  
  
  METHODS
  Retrospective analysis was performed on patients undergoing LRYGBP at an academic medical center between January 1998 and August 2003. Operations were performed by surgeons with different training backgrounds: without formal laparoscopic fellowship (S1, n=95); immediately following laparoscopic fellowship (S2, n=100); and with extensive laparoscopic experience post fellowship (S3, n=88). First assistants were attendings, fellows, or residents. The variables analyzed included demographics, operative times, estimated blood loss (EBL), rate of conversion, length of stay (LOS), ICU stay, re-operation/re-admission rate, and complications. Results were analyzed by ANOVA and Fisher's exact test.
  
  
  RESULTS
  There were significant differences among surgeons of different training backgrounds in EBL, LOS, rate of ICU admission, and intraoperative and late complications rates. Among assistants of different training levels, there were significant differences in operative time, EBL, intraoperative complication rates and re-admission rates.
  
  
  CONCLUSIONS
  Differences in training background of the surgeons resulted in significant differences in outcome, including EBL, LOS, ICU admission and intraoperative and late complication rates. Lower assistant training levels significantly impacted efficiency through lengthened operative times and increased EBL, as well as increased intraoperative complication rates and re-admission rates. Our results suggested that participating in a laparoscopic fellowship and operating with a more experienced assistant may improve outcomes during the learning curve.
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Gloria P
authors.initials: GP
authors.lastname: Hsu
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
authors.forename: Li
authors.initials: L
authors.lastname: Jin
authors.forename: Bassem Y
authors.initials: BY
authors.lastname: Safadi
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Satterwhite
authors.forename: Myriam J
authors.initials: MJ
authors.lastname: Curet
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D004501:Education, Medical; D005257:Fellowships and Scholarships; D005260:Female; D015390:Gastric Bypass / Q000193:education* / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology