Establishing Laparoscopic Roux-en-Y Gastric Bypass: Perioperative Outcome and Characteristics of the Learning Curve
- 197 Downloads
- 34 Citations
Abstract
Background
Bariatric surgery was established at several Norwegian hospitals in 2004. This study evaluates the perioperative outcome and the learning curves for two surgeons while introducing laparoscopic Roux-en-Y gastric bypass (LRYGB).
Methods
Morbidly obese patients undergoing primary LRYGB were included. Lengths of surgery and postoperative hospital stay, and 30-day rates of morbidity, reoperations, and readmissions were set as indicators of the learning curve. Learning effects were evaluated by graphical analyses and comparing the first and last 40 procedures for both surgeons.
Results
The 292 included patients had a mean age of 40.0 ± 9.5 years and a mean body mass index (BMI) of 46.7 ± 5.3 kg/m2. The mean length of surgery was 101 ± 55 min. Complications occurred in 43 patients (14.7%), with no conversions to open surgery in the primary procedure and no mortality. Reoperations were performed in 14 patients (4.8%), of which five patients required open surgery. The median length of stay was 3 days (range 1–77), and 19 patients (6.5%) were readmitted. High patient age, but not high BMI, was associated with an increased risk of complication. For both surgeons, lengths of surgery and hospital stay were significantly reduced (p < 0.001), leveling out after 100 procedures. Reductions in the rates of morbidity, reoperations and readmissions were not found.
Conclusion
LRYGB was introduced with an acceptable morbidity rate and no mortality. Only the length of surgery and postoperative hospital stay were suitable indicators of a learning curve, which comprised about 100 cases.
Keywords
Bariatric surgery Morbidity Learning Intraoperative complicationsNotes
Acknowledgement
TTS, JK, CFS, AN and TM have received travel grants from Johnson & Johnson and Covidien. ETA has received lecture fees from Johnson & Johnson, but all honoraria were donated directly to charity. Multidisciplinary team training courses in bariatric surgery have been arranged at Aker University Hospital with financial support from Johnson & Johnson.
References
- 1.Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.CrossRefGoogle Scholar
- 2.Ulset E, Undheim R, Malterud K. Has the obesity epidemic reached Norway? Tidsskr Nor Laegeforen. 2007;127:34–7.PubMedGoogle Scholar
- 3.Graff-Iversen S, Jenum AK, Grotvedt L, et al. Risk factors for myocardial infarction, stroke and diabetes in Norway. Tidsskr Nor Laegeforen. 2007;127:2537–41.PubMedGoogle Scholar
- 4.Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.CrossRefGoogle Scholar
- 5.Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefGoogle Scholar
- 6.Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. N Engl J Med. 2007;357:741–52.CrossRefGoogle Scholar
- 7.Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.CrossRefGoogle Scholar
- 8.Aasheim ET, Mala T, Sovik TT, et al. Surgical treatment of morbid obesity. Tidsskr Nor Laegeforen. 2007;127:38–42.PubMedGoogle Scholar
- 9.Sovik TT, Aasheim ET, Kristinsson J, et al. Surgical treatment of morbid obesity at a regional center. Tidsskr Nor Laegeforen. 2007;127:47–9.PubMedGoogle Scholar
- 10.Schauer P, Ikramuddin S, Hamad G, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc. 2003;17:212–5.CrossRefGoogle Scholar
- 11.Shikora SA, Kim JJ, Tarnoff ME, et al. Laparoscopic Roux-en-Y gastric bypass: results and learning curve of a high-volume academic program. Arch Surg. 2005;140:362–7.CrossRefGoogle Scholar
- 12.Breaux JA, Kennedy CI, Richardson WS. Advanced laparoscopic skills decrease the learning curve for laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21:985–8.CrossRefGoogle Scholar
- 13.Suter M, Paroz A, Calmes JM, et al. European experience with laparoscopic Roux-en-Y gastric bypass in 466 obese patients. Br J Surg. 2006;93:726–32.CrossRefGoogle Scholar
- 14.Andrew CG, Hanna W, Look D, et al. Early results after laparoscopic Roux-en-Y gastric bypass: effect of the learning curve. Can J Surg. 2006;49:417–21.PubMedPubMedCentralGoogle Scholar
- 15.Brasileiro AL, Miranda F Jr, Ettinger JE, et al. Incidence of lower limbs deep vein thrombosis after open and laparoscopic gastric bypass: a prospective study. Obes Surg. 2008;18:52–7.CrossRefGoogle Scholar
- 16.O’Rourke RW, Andrus J, Diggs BS, et al. Perioperative morbidity associated with bariatric surgery: an academic center experience. Arch Surg. 2006;141:262–8.CrossRefGoogle Scholar
- 17.Flancbaum L, Belsley S. Factors affecting morbidity and mortality of Roux-en-Y gastric bypass for clinically severe obesity: an analysis of 1,000 consecutive open cases by a single surgeon. J Gastrointest Surg. 2007;11:500–7.CrossRefGoogle Scholar
- 18.Benotti PN, Wood GC, Rodriguez H, et al. Perioperative outcomes and risk factors in gastric surgery for morbid obesity: a 9-year experience. Surgery. 2006;139:340–6.CrossRefGoogle Scholar
- 19.Flum DR, Salem L, Elrod JA, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294:1903–8.CrossRefGoogle Scholar
- 20.Sekhar N, Torquati A, Youssef Y, et al. A comparison of 399 open and 568 laparoscopic gastric bypasses performed during a 4-year period. Surg Endosc. 2007;21:665–8.CrossRefGoogle Scholar
- 21.Suter M, Giusti V, Heraief E, et al. Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Surg Endosc. 2003;17:603–9.CrossRefGoogle Scholar
- 22.Oliak D, Ballantyne GH, Weber P, et al. Laparoscopic Roux-en-Y gastric bypass: defining the learning curve. Surg Endosc. 2003;17:405–8.CrossRefGoogle Scholar
- 23.Lublin M, Lyass S, Lahmann B, et al. Levelling the learning curve for laparoscopic bariatric surgery. Surg Endosc. 2005;19:845–8.CrossRefGoogle Scholar