Surgical Endoscopy

, Volume 21, Issue 6, pp 985–988 | Cite as

Advanced laparoscopic skills decrease the learning curve for laparoscopic Roux-en-Y gastric bypass

  • Jason A. Breaux
  • Colleen I. Kennedy
  • William S. Richardson



The reported learning curve for laparoscopic Roux-en-Y gastric bypass (LRYGB) is 20–100 cases. Our aim was to investigate whether advanced laparoscopic skills could decrease the learning curve for LRYGB with regard to major morbidity.


The senior author performed all operations in this series. His training included a laparoscopic fellowship without bariatric surgery, six years in surgical practice focusing on upper abdominal laparoscopic surgery, two courses on bariatric surgery at national meetings, one week of observing a bariatric program, and two mentored LRGBY cases. A comprehensive obesity program was put in place before the program began. Data were collected prospectively and reviewed at the series’ end. Results are presented as mean ± standard deviation and standard statistical analysis was applied.


Between December 2003 and February 2005, 107 LRYGB operations were performed. Mean operative time decreased significantly with experience (p < 0.0001) and was 154 ± 29, 132 ± 40, 127 ± 29, and 114 ± 30 min by quartile. Mean length of stay was 2.9 ± 1.6 days. Mean excess weight loss was 45.3% (n = 41) at six months. There were no conversions to an open procedure, no anastomotic leaks, no pulmonary embolisms, and no bowel obstructions. The five major complications (3 in the first 50 and 2 in the last 57 cases, p = NS) were two cases of biliopancreatic limb obstruction, two cases of significant gastrointestinal bleeding from anastomotic ulcer, and one case of gastric volvulus of the remnant stomach.


A bariatric fellowship and/or extended mentoring are not required to safely initiate a bariatric program for surgeons with advanced laparoscopic skills. Operative time decreases significantly with experience, but morbidity and mortality remain low even early in the learning curve. A comprehensive obesity program seems necessary for success.


Morbid obesity Bariatric surgery Laparoscopic Roux-en-Y gastric bypass Learning curve 


  1. 1.
    Ballantyne GH, Ewing D, Capella RF, Capella JF, Davis D, Schmidt HJ, Wasielewski A, Davies RJ (2005) The learning curve measured by operative times for laparoscopic and open gastric bypass: roles of surgeon’s experience, institutional experience, body mass index, and fellowship training. Obes Surg 15: 172–182PubMedCrossRefGoogle Scholar
  2. 2.
    Brolin RE (1995) The anti-obstruction stitch in stapled Roux-en-Y enteroenterostomy. Am J Surg 169: 355–357PubMedCrossRefGoogle Scholar
  3. 3.
    DeMaria EJ, Sugerman HJ, Kellum JM, Meador J, Wolf LG (2002) Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 235: 640–647PubMedCrossRefGoogle Scholar
  4. 4.
    Dresel A, Kuhn JA, Westmoreland MV, Talaasen LJ, McCarty TM (2002) Establishing a laparoscopic gastric bypass program. Am J Surg 184: 617–620PubMedCrossRefGoogle Scholar
  5. 5.
    Gould JC, Garren MJ, Starling JR (2004) Lessons learned from the first 100 cases in a new minimally invasive bariatric surgery program. Obes Surg 14: 618–625PubMedCrossRefGoogle Scholar
  6. 6.
    Higa KD, Boone KB, Ho T, Davies OG (2000) Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg 135: 1029–1033PubMedCrossRefGoogle Scholar
  7. 7.
    Higa KD, Boone KB, Ho T (2000) Complications of the laparoscopic Roux-en-Y gastric bypass: 1040 patients—what have we learned? Obes Surg 10: 509–513PubMedCrossRefGoogle Scholar
  8. 8.
    Kligman MD, Thomas C, Saxe J (2003) Effect of the learning curve on the early outcomes of laparoscopic Roux-en-Y gastric bypass. Am Surg 69: 304–310PubMedGoogle Scholar
  9. 9.
    Lublin M, Lyass S, Lahmann B, Cunneen SA, Khalili TM, Elashoff JD, Phillips EH (2005) Leveling the learning curve for laparoscopic bariatric surgery. Surg Endosc 19: 845–848PubMedCrossRefGoogle Scholar
  10. 10.
    Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ, Wolfe BM (2001) Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 234: 279–289PubMedCrossRefGoogle Scholar
  11. 11.
    Oliak D, Ballantyne GH, Weber P, Wasielewski A, Davies RJ, Schmidt HJ (2003) Laparoscopic Roux-en-Y gastric bypass: defining the learning curve. Surg Endosc 17: 405–408PubMedCrossRefGoogle Scholar
  12. 12.
    Oliak D, Owens M, Schmidt HJ (2004) Impact of fellowship training on the learning curve for laparoscopic gastric bypass. Obes Surg 14: 197–200PubMedCrossRefGoogle Scholar
  13. 13.
    Papasavas PK, Hayetian FD, Caushaj PF, Landreneau RJ, Maurer J, Keenan RJ, Quinlin RF, Gagne DJ (2002) Outcome analysis of laparoscopic Roux-en-Y gastric bypass for morbid obesity. The first 116 cases. Surg Endosc 2002 16: 1653–1657CrossRefGoogle Scholar
  14. 14.
    Santry HP, Gillen DL, Lauderdale DS (2005) Trends in bariatric surgery. JAMA 294: 1909–1917PubMedCrossRefGoogle Scholar
  15. 15.
    Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232: 515–529PubMedCrossRefGoogle Scholar
  16. 16.
    Schauer PR, Ikramuddin S, Hamad G, Eid GM, Mattar S, Cottam D, Ramanathan R, Gourash W (2003) Laparoscopic gastric bypass surgery: current technique. J Laparoendosc Adv Surg Tech A 13: 229–239PubMedCrossRefGoogle Scholar
  17. 17.
    Shauer P, Ikramuddin S, Hamad G, Gourash W (2003) The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc 17: 212–215CrossRefGoogle Scholar
  18. 18.
    Shin R (2005) Evaluation of the learning curve for laparoscopic Roux-en-Y gastric bypass surgery. Surg Obes Related Dis 1: 91–94CrossRefGoogle Scholar
  19. 19.
    Suter M, Giusti V, Heraief E, Zysset F, Calmes JM (2003) Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Surg Endosc 17: 603–609PubMedCrossRefGoogle Scholar
  20. 20.
    Westling A, Gustavsson S (2001) Laparoscopic vs open Roux-en-Y gastric bypass: a prospective, randomized trial. Obes Surg 11: 284–292PubMedCrossRefGoogle Scholar
  21. 21.
    Williams MD, Champion JK (2004) Linear technique of laparoscopic Roux-en-Y bypass. Surg Technol Int 13: 101–105PubMedGoogle Scholar
  22. 22.
    Wittgrove AC, Clark GW (2000) Laparoscopic Roux-en-Y gastric bypass in 500 patients: technique and results, with 3–60 month follow-up. Obes Surg 10: 233–239PubMedCrossRefGoogle Scholar
  23. 23.
    Wittgrove AC, Clark GW, Tremblay LJ (1994) Laparoscopic gastric bypass, Roux-en-Y: preliminary report of 5 cases. Obes Surg 4: 353–357PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Jason A. Breaux
    • 1
  • Colleen I. Kennedy
    • 1
  • William S. Richardson
    • 1
  1. 1.Department of SurgeryOchsner Medical CenterNew OrleansUSA

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