A two-consultant approach is a safe and efficient strategy to adopt during the learning curve for laparoscopic Roux-en-Y gastric bypass: our results in the first 100 procedures

Abu-Hilal, M., Vanden Bossche, M., Bailey, I.S., Harb, A., Sutherland, R., Sansome, A.J. and Byrne, J.P. (2007) A two-consultant approach is a safe and efficient strategy to adopt during the learning curve for laparoscopic Roux-en-Y gastric bypass: our results in the first 100 procedures. Obesity Surgery, 17 (6), 742-746. (doi:10.1007/s11695-007-9137-8). (PMID:17879572)

Abstract

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) can be technically challenging. It is imperative that patient morbidity and mortality are minimized while teams are on the learning curve for this procedure.

Methods: This retrospective study evaluated the peri-operative risk of LRYGBP utilizing a two-consultant surgeon approach in a newly established bariatric service. 100 consecutive patients undergoing LRYGBP were included. Two consultants participated in each procedure.

Results: Median operative duration was 113 minutes (range 80–240) and fell with increasing experience [127 minutes (range 90–240) in cases 1–50 and 105 minutes (range 80–210) in cases 51–100; P?=?0.009]. Multivariate analysis found operation time correlated only with number of procedures performed (P?<?0.001). There were no conversions to laparotomy. Intra-operatively, 2 patients had hand-assisted completion of the jejuno-jejunostomy, and 2 underwent laparoscopic revision of the reconstruction. Postoperative complications were observed in 8 patients on the operative admission. Median stay was 4 days (range 3–7). 4 patients required readmission. There was no mortality. Percentage of excess BMI loss was 47%, 53% and 70% at 3, 6 and 12 months respectively.

Conclusion: A learning curve for LRYGBP is evidenced in this series by reduction in operative time with increasing experience. Complication rates in line with large published series can be achieved by adopting a two-surgeon approach, which we propose as a safe method to adopt in the development of new bariatric services.

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