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Influence of the Learning Curve on Safety and Efficiency of Laparoscopic Sleeve Gastrectomy

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Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric procedure, and data regarding the learning curve are scarce. The aim of this study is to assess how the procedure can be safely implanted in a newly established bariatric unit and to define the learning curve.

Methods

Proctorship and mentorship in bariatric surgery were attended by two surgeons who were previously experienced in advanced laparoscopic surgery. The first consecutive 102 patients who underwent LSG in our newly established bariatric center were included. Patients were divided into three groups of 34 (groups 1, 2, and 3) according to case sequence. Data on demographics, operative time, conversion rate, hospital stay, morbidity, mortality, and excess weight loss (EWL) over time were compared between the groups.

Results

The operative time was significantly lower in groups 2 (p = 0.016) and 3 (p = 0.003) compared to group 1. The learning curve was flat up to the 68th case. A significant decrease in hospital stay was noted for group 3 compared to groups 1 (p < 0.001) and 2 (p = 0.002). The conversion rate, mortality and morbidity rates, and EWL did not differ significantly between the groups. Mortality was 0.98% and procedure-related morbidity was 7.8%.

Conclusions

LSG can be safely and efficiently performed in a newly established bariatric center following a mentorship procedure. Proficiency seems to require 68 cases. The operative time and hospital stay may significantly decrease with experience early in the learning curve, as opposed to mortality and morbidity rates, conversion rate, and EWL.

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Acknowledgments

We thank F. Kalfarentzos, Professor of Surgery, University of Patras and K. Vagenas, Assistant Professor of Surgery, University of Patras, Greece.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, University Hospital of Larissa, Larissa, 41110, Viopolis, Greece

    Dimitris Zacharoulis, Eleni Sioka, Dimitris Papamargaritis, Eleni Zachari & George Tzovaras

  2. Department of Radiology, University Hospital of Larissa, Larissa, 41110, Viopolis, Greece

    Olga Lazoura & Christos Rountas

Authors
  1. Dimitris Zacharoulis
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  2. Eleni Sioka
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  3. Dimitris Papamargaritis
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  4. Olga Lazoura
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  5. Christos Rountas
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  6. Eleni Zachari
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  7. George Tzovaras
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Correspondence to Dimitris Zacharoulis.

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Zacharoulis, D., Sioka, E., Papamargaritis, D. et al. Influence of the Learning Curve on Safety and Efficiency of Laparoscopic Sleeve Gastrectomy. OBES SURG 22, 411–415 (2012). https://doi.org/10.1007/s11695-011-0436-8

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  • DOI: https://doi.org/10.1007/s11695-011-0436-8

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