A Stepwise Approach in Learning Surgical Residents a Roux-en-Y Gastric Bypass

  • A. B. Walinga
  • S. R. van Mil
  • L. U. Biter
  • M. Dunkelgrün
  • G. H. E. J. Vijgen
Original Contributions



This study describes a stepwise training program to teach a laparoscopic Roux-en-Y gastric bypass (LRYGB). Results of a resident are compared to experienced bariatric surgeons (EBS).


The resident performed a varying amount of surgical steps and the duration of every step was measured using video analysis. In order to compare the resident’s results to EBS, the average time per step was calculated for 30 procedures.


The total procedure time of LRYGB was 61.15 (± 8.74) min for a novice resident. In comparison, the average of three EBS was 36.22 (± 9.06) min. Creation of the gastric pouch had an average of 12.82 (± 4.08) versus 6.93 (± 2.58) min. Duration of creating the stapled gastrojejunostomy was 7.43 (± 2.11) versus 4.48 (± 2.02) min. Suturing of the gastrojejunostomy was 12.60 (± 3.31) compared to 6.31 (± 2.53) min. Creating the jejunojejunal anastomosis had a duration of 7.12 ( ±2.31) versus 4.22 (± 1.60) min and suturing this anastomosis was 13.93 (± 3.81) compared to 8.51 (± 3.37) min. At the end of the traineeship, the observed progression approximated the skills level of the EBS.


The stepwise LRYGB-training program, analysed in this study, can result in an efficient and safe way to approach the learning curve to the level of the EBS. Within this training program, the total time of the operation is kept low in order to prevent adverse events for the patient and loss of efficiency in the bariatric program. The results of this study could act as a guideline for the development of such training programs.


Bariatric surgery Roux-en-Y gastric bypass Morbid obesity Surgical residents Training program Learning curve 



We would like to thank the help of Rien van den Oever, Functional Application Manager OK/Anaesthesia.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • A. B. Walinga
    • 1
  • S. R. van Mil
    • 1
  • L. U. Biter
    • 1
  • M. Dunkelgrün
    • 1
  • G. H. E. J. Vijgen
    • 1
  1. 1.Department of SurgeryFranciscusRotterdamthe Netherlands

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