title: Procedural changes to decrease complications in laparoscopic gastric bypass.
abstract: OBJECTIVE
  Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a complex procedure performed in a patient population with significant medical comorbidities. Evaluation and modification of surgical techniques can minimize the complications associated with the lengthy learning curve for this procedure. The purpose of this study was to evaluate a single surgeon's decade-long experience with LRYGB, to determine whether complications decreased with experience and surgical modifications improved perioperative outcomes.
  
  
  METHODS
  A retrospective review of all procedures performed by a fellowship-trained surgeon (MK) from December 1, 2000, to October 31, 2013, identified patients who underwent LRYGB. We evaluated perioperative outcomes in 1117 patients and examined the impact of modification of surgical techniques on complications. The patients were divided into 4 groups: cases 1-100 (group 1), cases 101-400 (group 2), cases 401-700 (group 3), and cases 701-1117 (group 4).
  
  
  RESULTS
  Operating time decreased significantly after the initial 100 cases, from 179.1 minutes for group 1 to 122.1 minutes for group 4. With experience, early complication rates improved from 25.0% to 5.0%, but the rates of early reoperation increased from 1.0% to 2.2% over the 4 case groups. Late complication and reoperation rates increased from 4.0% to 10.5%. However, rates of bleeding, early stricture, internal hernia, and wound infection all decreased after the modification of surgical techniques.
  
  
  CONCLUSIONS
  Operating time and early complication rates decreased with operative experience, but late complication and early and late reoperation rates increased. However, after modifications of surgical technique, common complications of LRYGB decreased to rates lower than those reported in several gastric bypass case series in the literature. The findings in this study will be helpful to fellow bariatric surgeons who are refining their strategies for reducing morbidity related to LRGYB.
authors.affiliation: Department of Surgery, New York University Langone Medical Center.
authors.forename: Melissa
authors.initials: M
authors.lastname: Beitner
authors.affiliation: New York University School of Medicine.
authors.forename: Yuying
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Surgery, New York University Langone Medical Center.
authors.forename: Marina
authors.initials: M
authors.lastname: Kurian
mesh_terms: D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bariatric surgery; Complications; Laparoscopic Roux-en-Y gastric bypass; Learning curve; Morbid obesity
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