title: Overcoming the learning curve of laparoscopic Roux-en-Y gastric bypass: a 12-year experience.
abstract: BACKGROUND
  Surgical treatment of morbid obesity with laparoscopic Roux-en-Y gastric bypass (LRYGB) is technically challenging and involves high-risk patients. In this study, the short-term outcome of LRYGB in a large population of patients has been evaluated, and morbimortality before and after overcoming the learning curve has been assessed. The objective of this study was to establish the learning curve for laparoscopic Roux-en-Y gastric bypass.
  
  
  METHODS
  This retrospective study involved 2281 patients submitted to LRYGB at São José do Avaí Hospital between August 1999 and December 2011. The parameters analyzed were operating time, rates of short-term postoperative complications, mortality, and conversion.
  
  
  RESULTS
  The study population was predominantly female (71.3%) and presented a mean age of 37.5 years and mean body mass index (BMI) of 45.15 kg/m(2). The average time in surgery was 119 minutes, and average hospital stay was 4.3 days. The incidence of postoperative complications (hemorrhage, fistula, and bowel obstruction) was 1.75%. The relative risk of complications diminished in line with the increased experience of the surgical team and tended to stabilize at<2.5% after the first 500 procedures. The mortality rate was .43%, and the main causes of death were pulmonary embolism and leaks (.14% each). The conversion rate was .17%.
  
  
  CONCLUSIONS
  Operating time and risks of adverse outcome were significantly reduced after a long learning curve of 500 consecutive procedures. The number of surgeries performed and the standardization of the laparoscopic technique used were the main factors contributing to the low rates of postoperative complications, mortality, and conversion.
authors.affiliation: Department of Surgery, São José do Avaí Hospital, Itaperuna, Rio de Janeiro, Brazil.
authors.forename: Luciana
authors.initials: L
authors.lastname: El-Kadre
authors.forename: Augusto C
authors.initials: AC
authors.lastname: Tinoco
authors.forename: Renam C
authors.initials: RC
authors.lastname: Tinoco
authors.forename: Livia
authors.initials: L
authors.lastname: Aguiar
authors.forename: Tarciana
authors.initials: T
authors.lastname: Santos
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D001938:Brazil; D002983:Clinical Competence; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000379:methods / Q000706:statistics & numerical data; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Bariatric surgery; Laparoscopy; Learning curve; Morbid obesity; Roux-en-Y gastric bypass