title: How to train surgical residents to perform laparoscopic Roux-en-Y gastric bypass safely.
abstract: BACKGROUND
  As a result of increasing numbers of patients with morbid obesity there is a worldwide demand for bariatric surgeons. The Roux-en-Y gastric bypass, nowadays performed mostly laparoscopically (LRYGB), has been proven to be a highly effective surgical treatment for morbid obesity. This procedure is technically demanding and requires a long learning curve. Little is known about implementing these demanding techniques in the training of the surgical resident. The aim of this study was to evaluate the safety and feasibility of the introduction of LRYGB into the training of surgical residents.
  
  
  METHODS
  All patients who underwent LRYGB between March 2006 and July 2010 were retrospectively analyzed. The procedure was performed by a surgical resident under strict supervision of a bariatric surgeon (group I) or by a bariatric surgeon (group II). The primary end point was the occurrence of complications. Secondary end points included operative time, days of hospitalization, rate of readmission, and reappearance in the emergency department (ED) within 30 days.
  
  
  RESULTS
  A total of 409 patients were found eligible for inclusion in the study: 83 patients in group I and 326 in group II. There was a significant difference in operating time (129 min in group I vs. 116 min in group II; p < 0.001) and days of hospitalization. Postoperative complication rate, reappearance in the ED, and rate of readmission did not differ between the two groups.
  
  
  CONCLUSIONS
  Our data suggest that under stringent supervision and with sufficient laparoscopic practice, implementation of LRYGB as part of surgical training is safe and results in only a slightly longer operating time. Complication rates, days of hospitalization, and the rates of readmission and reappearance in the ED within 30 days were similar between the both groups. These results should be interpreted by remembering that all procedures in group I were performed in a training environment so occasional intervention by a bariatric surgeon, when necessary, was inevitable.
authors.affiliation: Department of Surgery, Maasstad Ziekenhuis, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands. g.iordens@erasmusmc.nl
authors.forename: Gijs I T
authors.initials: GI
authors.lastname: Iordens
authors.forename: René A
authors.initials: RA
authors.lastname: Klaassen
authors.forename: Esther M M
authors.initials: EM
authors.lastname: van Lieshout
authors.forename: Berry I
authors.initials: BI
authors.lastname: Cleffken
authors.forename: Erwin
authors.initials: E
authors.lastname: van der Harst
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000592:standards*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000193:education* / Q000592:standards*; D013502:General Surgery / Q000193:education* / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D010535:Laparoscopy / Q000193:education / Q000592:standards; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012449:Safety