Establishing laparoscopic Roux-en-Y gastric bypass: perioperative outcome and characteristics of the learning curve.
BACKGROUND
Bariatric surgery was established at several Norwegian hospitals in 2004. This study evaluates the perioperative outcome and the learning curves for two surgeons while introducing laparoscopic Roux-en-Y gastric bypass (LRYGB).


METHODS
Morbidly obese patients undergoing primary LRYGB were included. Lengths of surgery and postoperative hospital stay, and 30-day rates of morbidity, reoperations, and readmissions were set as indicators of the learning curve. Learning effects were evaluated by graphical analyses and comparing the first and last 40 procedures for both surgeons.


RESULTS
The 292 included patients had a mean age of 40.0 +/- 9.5 years and a mean body mass index (BMI) of 46.7 +/- 5.3 kg/m(2). The mean length of surgery was 101 +/- 55 min. Complications occurred in 43 patients (14.7%), with no conversions to open surgery in the primary procedure and no mortality. Reoperations were performed in 14 patients (4.8%), of which five patients required open surgery. The median length of stay was 3 days (range 1-77), and 19 patients (6.5%) were readmitted. High patient age, but not high BMI, was associated with an increased risk of complication. For both surgeons, lengths of surgery and hospital stay were significantly reduced (p < 0.001), leveling out after 100 procedures. Reductions in the rates of morbidity, reoperations and readmissions were not found.


CONCLUSIONS
LRYGB was introduced with an acceptable morbidity rate and no mortality. Only the length of surgery and postoperative hospital stay were suitable indicators of a learning curve, which comprised about 100 cases.
Faculty of Medicine, University of Oslo, Oslo, Norway. torgeir.sovik@akersykehus.no.
Torgeir T
TT
Søvik
Faculty of Medicine, University of Oslo, Oslo, Norway.|Department of Medicine, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway.
Erlend T
ET
Aasheim
Department of Gastrointestinal Surgery, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway.
Jon
J
Kristinsson
Department of Gastrointestinal Surgery, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway.
Carl Fredrik
CF
Schou
Aker University Hospital Research Center, Trondheimsveien 235, 0514, Oslo, Norway.
Lien My
LM
Diep
Faculty of Medicine, University of Oslo, Oslo, Norway.
Arild
A
Nesbakken
Department of Gastrointestinal Surgery, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway.
Tom
T
Mala
D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D002983:Clinical Competence; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000193:education* / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D007432:Intraoperative Period / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000009:adverse effects* / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009664:Norway; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome