Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass.
BACKGROUND
The concept that advanced surgical training can reduce or eliminate the learning curve for complex procedures makes logical sense but is difficult to verify and has not been tested for laparoscopic Roux-en-Y gastric bypass (LRYGB). We sought to determine if minimally invasive/bariatric surgery fellowship graduates (FGs) would demonstrate complication-related outcomes (CRO) equivalent to the outcomes achieved during their training experience under the supervision of experienced bariatric surgeons.


METHODS
We compared CRO for the first 100 consecutive LRYGBs performed in practice by five consecutive minimally invasive/bariatric fellows at new institutions (total 500 cases) to CRO for the 611 consecutive LRYGBs performed during their fellowship training experience under the supervision of three experienced bariatric surgeons at the host training institution.


RESULTS
The two patient groups did not differ demographically. The 18 types of major and minor complications identified after LRYGB did not differ among the five fellowship graduates. The mentors' CRO were compatible with published benchmark data. As compared with the training institution data, the overall incidence of complications for the combined experience of fellowship graduates did not differ statistically from that of the mentors. The fellowship graduates' early experience included zero non-gastrojejunostomy leaks (0% versus 1.5%) and a low rate of anastomotic stricture (0.8% versus 3.0%), incisional hernia (1% versus 4.4%), bowel obstruction (0% versus 3%), wound infection (0.3% versus 3.1%), and gastrointestinal hemorrhage (0.2% versus 1.6%). The rate of gastrojejunostomy leak (1.8% versus 2.6%) and, most importantly, mortality (0.8% versus 0.7%) did not differ between the two groups.


CONCLUSIONS
Fellowship graduates achieved high-quality surgical outcomes from the very beginning of their post-fellowship practices, which are comparable to those of their experienced mentors. These data validate the concept that advanced surgical training can eliminate the learning curve often associated with complex minimally invasive procedures, specifically LRYGB.
Ali
Mohamed R
MR
Department of Surgery, University of California, Davis, Sacramento, CA 95817, USA. mohamed.ali@ucdmc.ucdavis.edu
Tichansky
David S
DS
Kothari
Shanu N
SN
McBride
Corrigan L
CL
Fernandez
Adolfo Z
AZ
Sugerman
Harvey J
HJ
Kellum
John M
JM
Wolfe
Luke G
LG
DeMaria
Eric J
EJ
D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects / Q000193:education*; D004503:Education, Medical, Graduate; D005257:Fellowships and Scholarships; D005260:Female; D015390:Gastric Bypass / Q000193:education* / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000193:education*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D055815:Young Adult