Roux-en-Y Gastric Bypass Surgeon Experience
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Effect of Surgeon Experience on Laparoscopic Roux-en-Y Gastric Bypass Operations Open gastric bypass has been demonstrated to provide durable weight loss in morbidly obese patients. As laparoscopic techniques have evolved surgeons are offering patients such an approach for performance of gastric bypass. The purpose of this study was to evaluate the relationship between increasing experience and outcome for this technically challenging operation. Method A retrospective analysis was performed on the initial 160 consecutive patients undergoing laparoscopic roux-en-Y gastric bypass by a single surgeon over a 24-month period. Patients were divided into quartiles for data analysis. Results Duration of surgery decreased significantly between quartiles: 324 +/- 124, 225 +/- 70, 190 +/- 47, and 168 +/- 40 minutes, respectively. However, the conversion rate (3.1%) and mean hospital length of stay (2.1 +/- 2.4 days) were unaffected by surgeon experience. The early and late postoperative complication rates were 9.4 and 3.1 per cent, respectively. Early complications included: leak (1.3%), bleeding (3.8%), obstruction (1.9%), acute gastric distention (0.6%), subphrenic abscess (0.6%), and wound infection (0.6%). Late complications include: obstruction (1.3%), anastomotic stricture (1.3%), and marginal ulcer (0.6%). The complication rates did not change statistically between quartiles. The excess weight loss at one year was 77.4 +/- 16.7 per cent. These data suggest that throughout the learning curve laparoscopic gastric bypass can be accomplished with acceptable complication rates, conversion rates, and hospital length of stay. Conclusion Duration of laparoscopic roux-en-Y gastric bypass improves with experience. Early weight loss results compare favorably with those of open gastric bypass. Source: Laparoscopic Gastric Bypass Surgery to Reduce Obesity |