Are bariatric operations performed by residents safe and efficient?
BACKGROUND
The growing need for surgeons who are educated and trained in bariatric surgery has raised many issues related to training in this field.


OBJECTIVE
This study was performed to evaluate the safety and efficacy of laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) performed by doctors-in-training during their residency in general surgery.


METHODS
Tertiary referral university teaching hospital, Poland.


METHODS
We retrospectively analyzed the data of patients who underwent bariatric surgery. One group underwent surgery performed by at least third-year residents learning particular types of surgeries (trainee group), and the second group underwent surgeries performed by experienced bariatric surgeons (mentor group). The primary endpoint was the safety of the procedures. We analyzed factors related to the intraoperative and postoperative course. The secondary endpoint was long-term weight reduction. A lower body mass index (BMI), fewer co-morbidities, and preferably female sex were the selection criteria for patients in the trainee group.


RESULTS
We enrolled 408 patients who met all inclusion criteria. Among them, 233 underwent SG and 175 underwent LRYGB. For both SG and LRYGB, the median maximum preoperative weight was significantly lower in the trainee than mentor group. We found no statistically significant differences in the demographic factors or co-morbidities between the 2 groups. The median duration of SG and LRYGB surgery was significantly longer in the trainee than mentor group. The median number of stapler firings during SG was significantly lower in the trainee than mentor group. The number of stapler firings during LRYGB did not differ between the 2 groups. The incidence of intraoperative difficulties, which were based on the operator's subjective opinion, was higher in the trainee than mentor group for both SG and LRYGB. However, intraoperative difficulties had no significant impact on the intraoperative complication rate or risk of perioperative complications. The average percentage weight loss (%WL), percentage excess weight loss (%EWL), and percentage excess BMI loss (%EBMIL) in the all study group were 31.14%±9.11%, 56.17%±17.27%, and 65.42%±19.28%, respectively. For patients who underwent SG, we found no significant difference in %WL, %EWL, or %EBMIL between the trainee and mentor groups.


CONCLUSIONS
The performance of bariatric surgeries by residents does not affect the risk of reoperation, intraoperative adverse events, or surgical complications. Performance of SG and LRYGB by trainees takes significantly longer but has no untoward consequences for the patient. Both SG and LRYGB performed by a doctor-in-training and experienced operator lead to comparable outcomes in terms of weight reduction.
2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland. Electronic address: majorpiotr@gmail.com.
Piotr
P
Major
Students' Scientific Group at 2nd Department of Surgery, Jagiellonian University Medical College, Kraków, Poland.
Michał
M
Wysocki
2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
Jadwiga
J
Dworak
2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
Michał
M
Pędziwiatr
2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
Piotr
P
Małczak
2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
Andrzej
A
Budzyński
D000328:Adult; D050110:Bariatric Surgery / Q000193:education*; D004503:Education, Medical, Graduate; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000193:education / Q000379:methods; D015390:Gastric Bypass / Q000193:education / Q000379:methods; D013502:General Surgery / Q000193:education*; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000193:education* / Q000379:methods; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors
gastric bypass; learning curve; postoperative complications; resident; sleeve gastrectomy