Establishing Laparoscopic Roux-en-Y Gastric Bypass: Perioperative Outcome and Characteristics of the Learning Curve

Overview

Journal Obes Surg

Date 2008 Jun 21

PMID 18566869

Citations 22

Authors

Torgeir T Sovik

Erlend T Aasheim

Jon Kristinsson

Carl Fredrik Schou

Lien My Diep

Arild Nesbakken

Tom Mala

Affiliations

Soon will be listed here.

Abstract

Background: Bariatric surgery was established at several Norwegian hospitals in 2004. This study evaluates the perioperative outcome and the learning curves for two surgeons while introducing laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods: Morbidly obese patients undergoing primary LRYGB were included. Lengths of surgery and postoperative hospital stay, and 30-day rates of morbidity, reoperations, and readmissions were set as indicators of the learning curve. Learning effects were evaluated by graphical analyses and comparing the first and last 40 procedures for both surgeons.

Results: The 292 included patients had a mean age of 40.0 +/- 9.5 years and a mean body mass index (BMI) of 46.7 +/- 5.3 kg/m(2). The mean length of surgery was 101 +/- 55 min. Complications occurred in 43 patients (14.7%), with no conversions to open surgery in the primary procedure and no mortality. Reoperations were performed in 14 patients (4.8%), of which five patients required open surgery. The median length of stay was 3 days (range 1-77), and 19 patients (6.5%) were readmitted. High patient age, but not high BMI, was associated with an increased risk of complication. For both surgeons, lengths of surgery and hospital stay were significantly reduced (p < 0.001), leveling out after 100 procedures. Reductions in the rates of morbidity, reoperations and readmissions were not found.

Conclusion: LRYGB was introduced with an acceptable morbidity rate and no mortality. Only the length of surgery and postoperative hospital stay were suitable indicators of a learning curve, which comprised about 100 cases.

Citing Articles

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Health benefits and risks during 10 years after Roux-en-Y gastric bypass.

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References

Brasileiro A, Miranda Jr F, Ettinger J, Castro A, Pitta G, de Moura L . Incidence of lower limbs deep vein thrombosis after open and laparoscopic gastric bypass: a prospective study. Obes Surg. 2007; 18(1):52-7. DOI: 10.1007/s11695-007-9268-y. View

Flancbaum L, Belsley S . Factors affecting morbidity and mortality of Roux-en-Y gastric bypass for clinically severe obesity: an analysis of 1,000 consecutive open cases by a single surgeon. J Gastrointest Surg. 2007; 11(4):500-7. PMC: 1852384. DOI: 10.1007/s11605-007-0117-z. View

Graff-Iversen S, Jenum A, GrOtvedt L, Bakken B, Selmer R, Sogaard A . [Risk factors for myocardial infarction, stroke and diabetes in Norway]. Tidsskr Nor Laegeforen. 2007; 127(19):2537-41. View

Sovik T, Aasheim E, Kristinsson J, Schou C, Nesbakken A, Mala T . [Surgical treatment of morbid obesity at a regional center]. Tidsskr Nor Laegeforen. 2007; 127(1):47-9. View

Ulset E, Undheim R, Malterud K . [Has the obesity epidemic reached Norway?]. Tidsskr Nor Laegeforen. 2007; 127(1):34-7. View

Suter M, Paroz A, Calmes J, Giusti V . European experience with laparoscopic Roux-en-Y gastric bypass in 466 obese patients. Br J Surg. 2006; 93(6):726-32. DOI: 10.1002/bjs.5336. View

Buchwald H, Avidor Y, Braunwald E, Jensen M, Pories W, Fahrbach K . Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004; 292(14):1724-37. DOI: 10.1001/jama.292.14.1724. View

Schauer P, Ikramuddin S, Hamad G, Gourash W . The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc. 2002; 17(2):212-5. DOI: 10.1007/s00464-002-8857-z. View

Shikora S, Kim J, Tarnoff M, Raskin E, Shore R . Laparoscopic Roux-en-Y gastric bypass: results and learning curve of a high-volume academic program. Arch Surg. 2005; 140(4):362-7. DOI: 10.1001/archsurg.140.4.362. View

10.

Oliak D, Ballantyne G, Weber P, Wasielewski A, Davies R, Schmidt H . Laparoscopic Roux-en-Y gastric bypass: defining the learning curve. Surg Endosc. 2002; 17(3):405-8. DOI: 10.1007/s00464-002-8820-z. View

11.

Sekhar N, Torquati A, Youssef Y, Wright J, Richards W . A comparison of 399 open and 568 laparoscopic gastric bypasses performed during a 4-year period. Surg Endosc. 2007; 21(4):665-8. DOI: 10.1007/s00464-006-9151-2. View

12.

Breaux J, Kennedy C, Richardson W . Advanced laparoscopic skills decrease the learning curve for laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007; 21(6):985-8. DOI: 10.1007/s00464-007-9203-2. View

13.

Suter M, Giusti V, Heraief E, Zysset F, Calmes J . Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Surg Endosc. 2003; 17(4):603-9. DOI: 10.1007/s00464-002-8952-1. View

14.

Adams T, Gress R, Smith S, Halverson R, Simper S, Rosamond W . Long-term mortality after gastric bypass surgery. N Engl J Med. 2007; 357(8):753-61. DOI: 10.1056/NEJMoa066603. View

15.

Ogden C, Carroll M, Curtin L, McDowell M, Tabak C, Flegal K . Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006; 295(13):1549-55. DOI: 10.1001/jama.295.13.1549. View

16.

Aasheim E, Mala T, Sovik T, Kristinsson J, Bohmer T . [Surgical treatment of morbid obesity]. Tidsskr Nor Laegeforen. 2007; 127(1):38-42. View

17.

Lublin M, Lyass S, Lahmann B, Cunneen S, Khalili T, Elashoff J . Leveling the learning curve for laparoscopic bariatric surgery. Surg Endosc. 2005; 19(6):845-8. DOI: 10.1007/s00464-004-8201-x. View

18.

ORourke R, Andrus J, Diggs B, Scholz M, McConnell D, Deveney C . Perioperative morbidity associated with bariatric surgery: an academic center experience. Arch Surg. 2006; 141(3):262-8. DOI: 10.1001/archsurg.141.3.262. View

19.

Sjostrom L, Narbro K, Sjostrom C, Karason K, Larsson B, Wedel H . Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007; 357(8):741-52. DOI: 10.1056/NEJMoa066254. View

20.

Sjostrom L, Lindroos A, Peltonen M, Torgerson J, Bouchard C, Carlsson B . Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004; 351(26):2683-93. DOI: 10.1056/NEJMoa035622. View