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Three Hundred Laparoscopic Roux-en-Y Gastric Bypasses: Managing the Learning Curve in Higher Risk Patients

Obesity Surgery volume 20, pages 290–294 (2010)Cite this article

Abstract

Background

Bariatric surgery is expanding and the increasing workload needs to be undertaken safely in new surgical centres with no previous bariatric experience. The laparoscopic Roux-en-Y gastric bypass (LRYGB) has a steep learning curve with documented high risk. We present the results for the first 300 cases of LRYGB in a new centre.

Methods

Three hundred consecutive patients underwent LRYGB performed by a single surgeon. Four external surgeons mentored eight cases in the first 50. Demographic characteristics, body mass index (BMI) and operative time were collected prospectively and the Obesity Surgery Mortality Risk Score was used for risk stratification.

Results

The mean BMI of the patients increased during the series from 49.0 for the first group to 50.2 for the second group and to 51.0 for the third group (p < 0.05). The number of high-risk patients measured with the OS-MRS was 19/300 (6.3%) in the whole series. The mean operative time decreased from 163 min for the first 100 patients to 119 min for the second 100 and 94 for the third (p < 0.0001). In the first group, there were nine reoperations and two conversions to open surgery, compared to two reoperations and one conversion in the second group (p < 0.05). In the whole series, there were 12 early complications requiring re-operation, four conversions to open surgery and one mortality (patient 110, heart failure within 24 h).

Conclusions

A mentoring process ensures that LRYGB can be done safely in a newly established bariatric centre. The operative time reduces markedly after the learning curve.

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Funding Support

DJ Pournaras is funded by a Royal College of Surgeons of England Research Fellowship.

Conflict of Interest

The authors have no other conflict of interest to disclose.

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Affiliations

  1. Department of Bariatric Surgery, Musgrove Park Hospital, Taunton, UK

    Dimitrios J. Pournaras, Sadaf Jafferbhoy, Daniel R. Titcomb, Samer Humadi, Janet R. Edmond, David Mahon & Richard Welbourn

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  1. Dimitrios J. Pournaras
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  2. Sadaf Jafferbhoy
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  3. Daniel R. Titcomb
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  4. Samer Humadi
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  5. Janet R. Edmond
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  6. David Mahon
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  7. Richard Welbourn
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Correspondence to Richard Welbourn.

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Pournaras, D.J., Jafferbhoy, S., Titcomb, D.R. et al. Three Hundred Laparoscopic Roux-en-Y Gastric Bypasses: Managing the Learning Curve in Higher Risk Patients. OBES SURG 20, 290–294 (2010). https://doi.org/10.1007/s11695-009-9914-7

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  • DOI: https://doi.org/10.1007/s11695-009-9914-7

Keywords

  • Bariatric surgery
  • Roux-en-Y gastric bypass
  • Laparoscopic gastric bypass
  • Learning curve
  • Obesity Surgery Mortality Risk Score