Top

Surgical Endoscopy

Published in:

01-06-2005 | Original article

Leveling the learning curve for laparoscopic bariatric surgery

Authors: M. Lublin, S. Lyass, B. Lahmann, S. A. Cunneen, T. M. Khalili, J. D. Elashoff, E. H. Phillips

Published in: Surgical Endoscopy | Issue 6/2005

Abstract

Background

The learning curve for laparoscopic bariatric surgery is associated with increased morbidity and mortality.

Methods

The study included the first 100 patients undergoing laparoscopic Roux-en-Y gastric bypass (LGB) by a designated surgical team. Surgeon A operated as primary surgeon, with surgeon B assisting (Stage 1). Surgeon B learned LGB in stages: exposure and jejunojejunostomy (stage 2), gastric pouch (stage 3), gastrojejunostomy (stage 4), and sequence all steps (stage 5).

Results

Surgeon A achieved confidence with LGB after 20 cases and surgeon B after 25 cases (stage 2), 18 cases (stage 3), 21 cases (stage 4), and 16 cases (stage 5). Complications (8%) included small bowel obstruction (three); pulmonary embolus (two), and leak, stomal stenosis, and gastrogastric fistula (one each). There was a decreasing trend for operative duration, length of stay, and complications across the five stages (p < 0.05).

Conclusions

By transferring skills in stages, a laparoscopic bariatric program can be established with minimal morbidity and mortality.

Advance data from vital and health statistics20032001 National Hospital Discharge SurveyCenters for Disease Control and PreventionAtlanta

Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults (1998) Executive Summary. National Institutes of Health, National Heart, Lung, and Blood Institute, Washington, DC, pp 1–26

DeMaria, EJ, Sugerman, HJ, Kellum, JM, Meador, JG, Wolfe, LG 2002Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesityAnn Surg235640647CrossRefPubMed

Dresel, A, Kuhn, JA, Westmoreland, MV, Talaasen, LJ, McCarty, TM 2002Establishing a laparoscopic gastric bypass programAm J Surg184617620CrossRefPubMed

Finkelstein, EA, Fiebelkorn, IC, Wang, G 2004State-Level estimates of annual medical expenditures attributable to obesityObes Res121824PubMed

Frangou, C 2004Is the bar set too high for bariatric outcomes?Gen Surg News311819

Higa, KD, Boone, KB, Ho, T, Davies, OG 2000Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patientsArch Surg13510291033CrossRefPubMed

Kligman, MD, Thomas, C, Saxe, J 2003Effect of the learning curve on the early outcomes of laparoscopic Roux-en-Y gastric bypassJ Am Surg69304310

National Health and Nutrition Examination Survey (NHANES) (1999) Centers for Disease Control and Prevention, Atlanta

10.

National Institutes of Health conference1991Gastrointestinal surgery for severe obesityConsensus Development Conference Panel. Ann Intern Med115956961

11.

Nguyen, NT, Goldman, C, Rosenquist, CJ, Arango, A, Cole, CJ, Lee, SJ, Wolfe, BM 2001Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costsAnn Surg234279291CrossRefPubMed

12.

Nguyen, NT, Rivers, R, Wolfe, BM 2003Factors associated with operative outcomes in laparoscopic gastric bypassJ Am Coll Surg197548557CrossRefPubMed

13.

Oliak, D, Ballantyne, GH, Weber, P, Wasielewski, A, Davies, RJ, Schmidt, HJ 2003Laparoscopic Roux-en-Y gastric bypass: defining the learning curveSurg Endosc17405408CrossRefPubMed

14.

Papasavas, PK, Caushaj, PF, McCormick, JT, Quinlin, RF, Hayetian, FD, Maurer, J, Kelly, JJ, Gagne, DJ 2003Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesitySurg Endosc17610614CrossRefPubMed

15.

Peck, AC, Detweiler, MC 2000Training concurrent multistep procedural tasksHum Factors42379389PubMed

16.

Personal communication (2004) American Society for Bariatric Surgery, San Diego

17.

Russell, TR 2003What is the future of surgery?Arch Surg138825831CrossRefPubMed

18.

Schauer, P, Ikramuddin, S, Hamad, G, Gourash, W 2003The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 casesSurg Endosc17212215CrossRefPubMed

19.

Smith, GJ 1999Teaching a long sequence of behavior using whole task training, forward chaining, and backward chainingPercept Motor Skills89951965PubMed

20.

Suter, M, Giusti, V, Heraief, E, Zysset, F, Calmes, JM 2003Laparoscopic Roux-en-Y gastric bypass: initial 2-year experienceSurg Endosc17603609CrossRefPubMed

21.

Wittgrove, AC, Clark, GW 2000Laparoscopic gastric bypass, Roux-en-Y—500 patients: technique and results, with 3–60 month follow-upObes Surg10233239CrossRefPubMed

22.

Wittgrove, AC, Clark, GW, Tremblay, LJ 1994Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five casesObes Surg4353357CrossRefPubMed

Title: Leveling the learning curve for laparoscopic bariatric surgery
Authors: M. Lublin
S. Lyass
B. Lahmann
S. A. Cunneen
T. M. Khalili
J. D. Elashoff
E. H. Phillips
Publication date: 01-06-2005
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 6/2005
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-004-8201-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Leveling the learning curve for laparoscopic bariatric surgery

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2005

Technical skills errors in laparoscopic cholecystectomy by expert surgeons

Laparoscopic adrenalectomy for malignant neoplasm: Our experience in 15 cases

Telerobotic-assisted laparoscopic hysterectomy for benign and oncologic pathologies: initial clinical experience with 30 patients

Evaluation of adhesion formation, mesh fixation strength, and hydroxyproline content after intraabdominal placement of polytetrafluoroethylene mesh secured using titanium spiral tacks, nitinol anchors, and polypropylene suture or polyglactin 910 suture

Low-grade B-cell MALT lymphoma of the stomach: a clinical challenge

Impact of video colonoscopy on stage and outcome of patients with symptomatic colorectal cancer