title: Redesigning the process of laparoscopic sleeve gastrectomy based on risk analysis resulted in 100 consecutive procedures without complications.
abstract: BACKGROUND
  In recent years, laparoscopic sleeve gastrectomy (LSG) is becoming increasingly popular. The quite simple technique, lack of anastomoses, fully stapling course of the resection and the laparoscopic approach influence the attractiveness of the procedure from the surgeon's perspective. Though the feasibility of LSG is appreciated, the range of complications seems to be considerable.
  
  
  OBJECTIVE
  To prospectively evaluate modification of the bariatric process in LSG patients.
  
  
  METHODS
  The initial results of the first series of LSG patients (G1) were unacceptable and led to redefinition, based on risk analysis, of the entire bariatric process. A number of corrective and preventive actions were implemented into the process. The impact of innovations on the outcomes of the next 100 LSGs (G2) was assessed. Complications, intraoperative difficulties and postoperative adverse events were registered.
  
  
  RESULTS
  The total complication rate of the G1 group was 32% (8/25 patients). When several corrective and preventive actions were implemented in the subsequent process, there were no postoperative complications observed in the G2 group. Sixteen intraoperative difficulties were encountered in group G2 but resolved intraoperatively and did not affect the postoperative course.
  
  
  CONCLUSIONS
  The systemic approach to the LSG procedure by innovating the entire process significantly reduced the rate of complications. The 'learning curve' should not be limited only to the manual operative training. Preventive actions based on risk analysis should be considered as the core component in redesigning the process.
authors: Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland.
authors: Lukasz
authors: L
authors: Kaska
authors: Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland.
authors: Monika
authors: M
authors: Proczko
authors: Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland.
authors: Tomasz
authors: T
authors: Stefaniak
authors: Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland.
authors: Jarek
authors: J
authors: Kobiela
authors: Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland.
authors: Zbigniew
authors: Z
authors: Sledziński
keywords: ISO; bariatric surgery; complications; laparoscopic sleeve gastrectomy; preventive actions; sleeve gastrectomy