A new and simplified technique for laparoscopic gastric bypass in a residency training program: decreased resource utilization and enhanced training.
BACKGROUND
Laparoscopic gastric bypass (LGB) is an advanced complex procedure. Teaching programs must balance resident training and participation with resource utilization, patient safety, and outcomes. We prospectively studied a new simplified LGB technique (S-LGB) in a residency training program.


METHODS
Prospective observational study.


METHODS
Academic bariatric program.


METHODS
All patients undergoing S-LGB during 17 months.


METHODS
Clinical data collection and surgeon survey.


METHODS
Resource utilization, patient outcomes, and resident/staff satisfaction.


RESULTS
There were 140 S-LGB operations performed by 4 staff members, all with postgraduate year 2 through 5 residents. There were no major intraoperative complications and no anastomotic leaks or deaths. Mean operative time for cases with no concurrent procedures was 91 minutes, with no intraoperative transfusions and 1 conversion to an open procedure. Compared with our standard technique, operative times with simple S-LGB decreased by an average of 56% for all staff (range, 45%-60%; P < .01). Lower postgraduate year level increased operative times with the standard technique but not with S-LGB. The anastomotic stricture rate decreased from 10.0% to 3.6% (P = .02). The mean excess body weight lost at 3, 6, and 12 months was 42%, 55%, and 87%, respectively. All staff surgeons preferred the S-LGB technique for technical difficulty, speed, safety, and ability to teach residents. Residents scored the S-LGB significantly better than our standard technique for difficulty, learning curve, and overall satisfaction (all P < .05).


CONCLUSIONS
Introduction of S-LGB has resulted in excellent outcomes and significant reductions in resource utilization while enhancing opportunities for resident teaching and full participation.
Martin
Matthew J
MJ
Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Ave., Tacoma, WA 98431-1100, USA. matthew.martin1@amedd.army.mil
Eckert
Matthew J
MJ
Eggebroten
William E
WE
Beekley
Alec C
AC
D015390:Gastric Bypass / Q000193:education* / Q000295:instrumentation / Q000379:methods*; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods*; D011446:Prospective Studies; D017792:Surgical Stapling / Q000379:methods