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Open Access 28-09-2022 | Original Article

Safety and efficacy of OAGB/MGB during the learning curve: setting a benchmark in a bariatric center of excellence

Authors: Mario Musella, Giovanna Berardi, Nunzio Velotti, Vincenzo Schiavone, Cristina Manetti, Antonio Vitiello

Published in: Updates in Surgery | Issue 1/2023

Abstract

Very little has been published on the learning curve (LC) of the One Anastomosis /Mini Gastric Bypass (OAGB/MGB). Aim of this study was to compare perioperative outcomes of OABG/MGBs performed during the LC of an experienced laparoscopic surgeon to global benchmark cut-offs. First 200 patients undergoing OAGB/MGB at our university hospital from 2010 to 2016 were retrospectively included in this study. LC of the surgeon was divided in two groups of 100 consecutive patients each and perioperative outcomes were compared to abovementioned global benchmarks for LSG and RYGB. A cumulative sum (CUSUM) analysis was performed for operative time and hospital stay. Uneventful postoperative recovery was recorded in 95% of patients. All benchmark values for RYGB were met in group 2. Comparison with cut-offs for LSG showed longer hospital stay and operative time in both groups but postoperative rate of complications resulted lower even for Group 1. CUSUM graph of the operative time runs randomly above the predetermined limit till the 40th cases but reaches the plateau after the 115th operation. CUSUM curve of the hospital stay reaches the plateau after the 57th case. OAGB/MGB confirms to be a feasible procedure, which can be safely and effectively performed during the learning curve. However, at least 100 hundred cases are required to reduce operative time and hospital stay.

Mason EE, Ito C (1967) Gastric bypass in obesity. Surg Clin N Am 47:1345–1351CrossRef

Rutledge R (2001) The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg 11:276–280CrossRef

Fisher BL, Buchwald H, Clark W et al (2001) Mini-gastric bypass controversy. Obes Surg 11(6):773–777CrossRef

Carbajo MA, Garcia-Caballero M, Toledano M et al (2005) One anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg 15:398–404CrossRef

Musella M, Susa A, Greco F et al (2014) The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review. Surg Endosc 28:156–163CrossRef

Lee WJ, Ser KH, Lee YC (2012) Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg 22:1827–1834CrossRef

https://asmbs.org/resources/endorsed-procedures-and-devices. Accessed 20 Oct 2021

Welbourn R, Hollyman M, Kinsman R et al (2019) Bariatric surgery worldwide: Baseline demographic description and one-year outcomes from the fourth IFSO Global Registry Report 2018. Obes Surg 29(3):782–795. https://doi.org/10.1007/s11695-018-3593-1CrossRef

Rheinwalt KP, Plamper A, Rückbeil MV, Kroh A, Neumann UP, Ulmer TF (2020) One anastomosis gastric bypass-mini-gastric bypass (OAGB-MGB) versus Roux-en-Y Gastric Bypass (RYGB)-a mid-term cohort study with 612 patients. Obes Surg 30(4):1230–1240. https://doi.org/10.1007/s11695-019-04250-3CrossRef

10.

Jia D, Tan H, Faramand A, Fang F (2020) One anastomosis gastric bypass versus Roux-en-Y Gastric bypass for obesity: a systematic review and meta-analysis of randomized clinical trials. Obes Surg 30(4):1211–1218. https://doi.org/10.1007/s11695-019-04288-3CrossRef

11.

Lo HC (2020) The learning curve of one anastomosis gastric bypass and its impact as a preceding procedure to Roux-en Y gastric bypass: initial experience of one hundred and five consecutive cases. BMC Surg 20(1):37. https://doi.org/10.1186/s12893-020-00697-9CrossRef

12.

Shikora SA, Kim JJ, Tarnoff ME et al (2005) Laparoscopic roux-en-y gastric bypass: results and learning curve of a high-volume academic program. Arch Surg 140(4):362–367CrossRef

13.

Schauer P, Ikramuddin S, Hamad G et al (2003) The learning curve for laparoscopic roux-en-y gastric bypass is 100 cases. Surg Endosc 17(2):212–215CrossRef

14.

Vitiello A, Berardi G, Velotti N et al (2021) Learning curve and global benchmark values of laparoscopic sleeve gastrectomy: results of first 100 cases of a newly trained surgeon in an Italian center of excellence. Updates Surg 73:1891–1898. https://doi.org/10.1007/s13304-021-01121-4CrossRef

15.

Casella G, Soricelli E, Giannotti D, Bernieri MG, Genco A, Basso N, Redler A (2016) Learning curve for laparoscopic sleeve gastrectomy: role of training in a high-volume bariatric center. Surg Endosc 30(9):3741–3748. https://doi.org/10.1007/s00464-015-4670-3CrossRef

16.

Gero D, Raptis DA, Vleeschouwers W, van Veldhuisen SL, Martin AS, Xiao Y, Galvao M, Giorgi M, Benois M, Espinoza F, Hollyman M, Lloyd A, Hosa H, Schmidt H, Garcia-Galocha JL, van de Vrande S, Chiappetta S, Menzo EL, Aboud CM, Lüthy SG, Orchard P, Rothe S, Prager G, Pournaras DJ, Cohen R, Rosenthal R, Weiner R, Himpens J, Torres A, Higa K, Welbourn R, Berry M, Boza C, Iannelli A, Vithiananthan S, Ramos A, Olbers T, Sepúlveda M, Hazebroek EJ, Dillemans B, Staiger RD, Puhan MA, Peterli R, Bueter M (2019) Defining Global benchmarks in bariatric surgery: a retrospective multicenter analysis of minimally invasive Roux-en-Y Gastric bypass and sleeve gastrectomy. Ann Surg 270(5):859–867. https://doi.org/10.1097/SLA.0000000000003512CrossRef

17.

Fried M, Yumuk V, Oppert JM et al (2014) Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg 24(1):42–55CrossRef

18.

Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240(2):205–213CrossRef

19.

Musella M, Milone M, Gaudioso D et al (2014) A decade of bariatric surgery. What have we learned? Outcome in 520 patients from a single institution. Int J Surg 12(Suppl 1):S183–S188. https://doi.org/10.1016/j.ijsu.2014.05.012CrossRef

20.

Musella M, Vitiello A, Berardi G, Velotti N, Pesce M, Sarnelli G (2020) Evaluation of reflux following sleeve gastrectomy and one anastomosis gastric bypass: 1-year results from a randomized open-label controlled trial. Surg Endosc. https://doi.org/10.1007/s00464-020-08182-3CrossRef

21.

Lee WJ, Wang W, Lee YC et al (2008) Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight. Obes Surg 18(3):294–299. https://doi.org/10.1007/s11695-007-9367-9CrossRef

22.

Morató O, Poves I, Burdío F, Sánchez-Velázquez P, Duran X, Grande L (2020) Evaluation of the learning curve for laparoscopic pancreatoduodenectomy by CUSUM analyses. Cohort study Int J Surg 80:61–67. https://doi.org/10.1016/j.ijsu.2020.05.009CrossRef

23.

Biau DJ, Williams SM, Schlup MM, Nizard RS, Porcher R (2008) Quantitative and individualized assessment of the learning curve using LC-CUSUM. Br J Surg 95(7):925–929. https://doi.org/10.1002/bjs.6056CrossRef

24.

Parmar CD, Mahawar KK, Boyle M, Carr WR, Jennings N, Schroeder N, Balupuri S, Small PK (2016) Mini gastric bypass: first report of 125 consecutive cases from United Kingdom. Clin Obes 6(1):61–67CrossRef

25.

Wang W, Wei PL, Lee YC, Huang MT, Chiu CC, Lee WJ (2005) Short-term results of laparoscopic mini-gastric bypass. Obes Surg 15(5):648–654CrossRef

26.

Aktimur R, Kirkil C, Yildirim K, Kutluer N (2018) Enhanced recovery after surgery (ERAS) in one-anastomosis gastric bypass surgery: a matched-cohort study. Surg Obes Relat Dis 14(12):1850–1856. https://doi.org/10.1016/j.soard.2018.08.029CrossRef

27.

Ramos AC, Chevallier JM, Mahawar K, IFSO Consensus Conference Contributors et al (2020) IFSO (International Federation for Surgery of Obesity and Metabolic Disorders) consensus conference statement on one-anastomosis gastric bypass (OAGB-MGB): results of a modified delphi study. Obes Surg 30(5):1625–1634. https://doi.org/10.1007/s11695-020-04519-yCrossRef

28.

Soong TC, Almalki OM, Lee WJ, Ser KH, Chen JC, Wu CC, Chen SC (2019) Measuring the small bowel length may decrease the incidence of malnutrition after laparoscopic one-anastomosis gastric bypass with tailored bypass limb. Surg Obes Relat Dis. https://doi.org/10.1016/j.soard.2019.08.010CrossRef

29.

Carbajo MA, Luque-de-León E, Jiménez JM et al (2017) Laparoscopic one-anastomosis gastric bypass: technique, results, and long-term follow-up in 1200 patients. Obes Surg 27(5):1153–1167CrossRef

30.

Musella M, Berardi G, Vitiello A (2020) Laparoscopic conversion from mini gastric bypass/1 anastomosis gastric bypass to Roux-en-Y gastric bypass for perforated marginal ulcer: video case report. Surg Obes Relat Dis 16(12):2125–2126. https://doi.org/10.1016/j.soard.2020.09.033CrossRef

Title: Safety and efficacy of OAGB/MGB during the learning curve: setting a benchmark in a bariatric center of excellence
Authors: Mario Musella
Giovanna Berardi
Nunzio Velotti
Vincenzo Schiavone
Cristina Manetti
Antonio Vitiello
Publication date: 28-09-2022
Publisher: Springer International Publishing
Published in: Updates in Surgery / Issue 1/2023
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-022-01380-9

Keynote webinar | Spotlight on medication adherence

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Safety and efficacy of OAGB/MGB during the learning curve: setting a benchmark in a bariatric center of excellence

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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