title: Three hundred laparoscopic Roux-en-Y gastric bypasses: managing the learning curve in higher risk patients.
abstract: BACKGROUND
  Bariatric surgery is expanding and the increasing workload needs to be undertaken safely in new surgical centres with no previous bariatric experience. The laparoscopic Roux-en-Y gastric bypass (LRYGB) has a steep learning curve with documented high risk. We present the results for the first 300 cases of LRYGB in a new centre.
  
  
  METHODS
  Three hundred consecutive patients underwent LRYGB performed by a single surgeon. Four external surgeons mentored eight cases in the first 50. Demographic characteristics, body mass index (BMI) and operative time were collected prospectively and the Obesity Surgery Mortality Risk Score was used for risk stratification.
  
  
  RESULTS
  The mean BMI of the patients increased during the series from 49.0 for the first group to 50.2 for the second group and to 51.0 for the third group (p < 0.05). The number of high-risk patients measured with the OS-MRS was 19/300 (6.3%) in the whole series. The mean operative time decreased from 163 min for the first 100 patients to 119 min for the second 100 and 94 for the third (p < 0.0001). In the first group, there were nine reoperations and two conversions to open surgery, compared to two reoperations and one conversion in the second group (p < 0.05). In the whole series, there were 12 early complications requiring re-operation, four conversions to open surgery and one mortality (patient 110, heart failure within 24 h).
  
  
  CONCLUSIONS
  A mentoring process ensures that LRYGB can be done safely in a newly established bariatric centre. The operative time reduces markedly after the learning curve.
authors.affiliation: Department of Bariatric Surgery, Musgrove Park Hospital, Taunton, UK.
authors.forename: Dimitrios J
authors.initials: DJ
authors.lastname: Pournaras
authors.forename: Sadaf
authors.initials: S
authors.lastname: Jafferbhoy
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Titcomb
authors.forename: Samer
authors.initials: S
authors.lastname: Humadi
authors.forename: Janet R
authors.initials: JR
authors.lastname: Edmond
authors.forename: David
authors.initials: D
authors.lastname: Mahon
authors.forename: Richard
authors.initials: R
authors.lastname: Welbourn
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002983:Clinical Competence; D005260:Female; D015390:Gastric Bypass / Q000193:education* / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D007432:Intraoperative Period; D010535:Laparoscopy; D007858:Learning; D008297:Male; D008611:Mentors; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome