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World Journal of Surgery

, Volume 36, Issue 9, pp 2003–2010 | Cite as

How to Train Surgical Residents to Perform Laparoscopic Roux-en-Y Gastric Bypass Safely

  • Gijs I. T. Iordens
  • René A. Klaassen
  • Esther M. M. van Lieshout
  • Berry I. Cleffken
  • Erwin van der Harst
Article

Abstract

Background

As a result of increasing numbers of patients with morbid obesity there is a worldwide demand for bariatric surgeons. The Roux-en-Y gastric bypass, nowadays performed mostly laparoscopically (LRYGB), has been proven to be a highly effective surgical treatment for morbid obesity. This procedure is technically demanding and requires a long learning curve. Little is known about implementing these demanding techniques in the training of the surgical resident. The aim of this study was to evaluate the safety and feasibility of the introduction of LRYGB into the training of surgical residents.

Methods

All patients who underwent LRYGB between March 2006 and July 2010 were retrospectively analyzed. The procedure was performed by a surgical resident under strict supervision of a bariatric surgeon (group I) or by a bariatric surgeon (group II). The primary end point was the occurrence of complications. Secondary end points included operative time, days of hospitalization, rate of readmission, and reappearance in the emergency department (ED) within 30 days.

Results

A total of 409 patients were found eligible for inclusion in the study: 83 patients in group I and 326 in group II. There was a significant difference in operating time (129 min in group I vs. 116 min in group II; p < 0.001) and days of hospitalization. Postoperative complication rate, reappearance in the ED, and rate of readmission did not differ between the two groups.

Conclusions

Our data suggest that under stringent supervision and with sufficient laparoscopic practice, implementation of LRYGB as part of surgical training is safe and results in only a slightly longer operating time. Complication rates, days of hospitalization, and the rates of readmission and reappearance in the ED within 30 days were similar between the both groups. These results should be interpreted by remembering that all procedures in group I were performed in a training environment so occasional intervention by a bariatric surgeon, when necessary, was inevitable.

Keywords

Methylene Blue Sleeve Gastrectomy Gastric Pouch Leak Test Gastrojejunal Anastomosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Maurik Stomps for his artistic impression of the three most important technical steps of the laparoscopic Roux-en-Y gastric bypass.

Disclosures

Drs. G. I. T. Iordens, R. A. Klaassen, E. M. M. van Lieshout, B. I. Cleffken, and E. van der Harst, have no conflicts of interest or financial ties to disclose.

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Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Gijs I. T. Iordens
    • 1
    • 2
  • René A. Klaassen
    • 1
  • Esther M. M. van Lieshout
    • 2
  • Berry I. Cleffken
    • 1
  • Erwin van der Harst
    • 1
  1. 1.Department of SurgeryMaasstad ZiekenhuisRotterdamThe Netherlands
  2. 2.Department of Surgery-TraumatologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands

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