title: Learning curve of laparoscopic Roux-en-Y gastric bypass in an Asian low-volume bariatric unit.
abstract: BACKGROUND
  Obesity has become a healthcare burden in Taiwan and the rest of Asia. Laparoscopic Roux-en-Y gastric bypass (LRYGB) provides good weight loss outcome, and improves comorbidity as well as quality of life. We present our experience of the learning curve for LRYGB in a low-volume bariatric unit.
  
  
  METHODS
  From March 2009 to August 2011, 60 consecutive patients who underwent LRYGB were included. They were separated into two groups, with the first 30 cases in Group 1 and the remaining 30 cases in Group 2. Indicators for evaluating the learning curve for LRYGB included surgical time, rate of conversion to open surgery, surgical and total complication rates, length of hospital stay, mortality, and postoperative weight loss.
  
  
  RESULTS
  There were no significant differences in demographic measurements between the two groups. In Group 1, the median surgical time was 120 minutes and in Group 2 it was 80 minutes (p<0.01). Two cases were converted to laparotomy in Group 1, but none in Group 2. There was no surgical mortality and the total complication rate of all patients was 16.7%. The complication rate significantly decreased from Group 1 (26.7%) to Group 2 (6.7%). Three patients needed further surgical procedures in Group 1, with no patients needing them in Group 2. There was no significant difference in hospital stay and percentage excess weight loss between the two groups.
  
  
  CONCLUSIONS
  The learning curve for LRYGB has no mortality and an acceptable complication rate. The operating time and morbidity rate are the indicators for overcoming the learning curve.
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shih-Chiang
authors.initials: SC
authors.lastname: Shen
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chun-Yi
authors.initials: CY
authors.lastname: Tsai
authors.affiliation: Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Liao
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yu-Yin
authors.initials: YY
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ta-Sen
authors.initials: TS
authors.lastname: Yeh
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan. Electronic address: kenghao@adm.cgmh.org.tw.
authors.forename: Keng-Hao
authors.initials: KH
authors.lastname: Liu
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D061846:Hospitals, Low-Volume; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013624:Taiwan; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
keywords: Asia; laparoscopic Roux-en-Y gastric bypass; learning curve; low-volume unit