Laparoscopic Gastric Bypass, Roux en-Y - 500 Patients: Technique and Results, with 3-60 month follow-up

Wittgrove, Alan C.; Clark, G Wesley

doi:10.1381/096089200321643511

Cited by 783 publications

(395 citation statements)

References 7 publications

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“…While it is possible that the MI faculty had not completely climbed their own learning curves for LRYGB during the early period of fellowship training and that this could represent a bias in the current study, the MI demonstrated CRO for LRYGB comparable to other published benchmark data for cases performed during the period of training [25]. Specifically, the rates of significant complications for the MI, detailed in Table 2, were within the ranges established in landmark publications describing experience with LRYGB [26][27][28]. The MI rate of GJ leak (2.6%) falls within the range of 0-3.6% established in these studies [26][27][28].…”

Section: Discussionsupporting

confidence: 57%

“…Specifically, the rates of significant complications for the MI, detailed in Table 2, were within the ranges established in landmark publications describing experience with LRYGB [26][27][28]. The MI rate of GJ leak (2.6%) falls within the range of 0-3.6% established in these studies [26][27][28]. Internal hernia occurred in 2.0% of MI patients and in 0.3-3.0% of cases in these studies [27,28].…”

Section: Discussionmentioning

confidence: 56%

“…Internal hernia occurred in 2.0% of MI patients and in 0.3-3.0% of cases in these studies [27,28]. Non-GJ leak occurred in 1.5% (reference range from benchmark data: 1.5-1.8%) of patients at the MI, and pulmonary embolism occurred in 0.7% of patients (reference range from benchmark data: 0-0.7%) [26][27][28]. Similarly, 0.2% of MI patients developed JJ obstruction and 0.2% developed GI hemorrhage as compared with published rates of 0.7% for JJ obstruction and 0.3-0.8% for GI hemorrhage [26][27][28].…”

Section: Discussionmentioning

confidence: 77%

“…Non-GJ leak occurred in 1.5% (reference range from benchmark data: 1.5-1.8%) of patients at the MI, and pulmonary embolism occurred in 0.7% of patients (reference range from benchmark data: 0-0.7%) [26][27][28]. Similarly, 0.2% of MI patients developed JJ obstruction and 0.2% developed GI hemorrhage as compared with published rates of 0.7% for JJ obstruction and 0.3-0.8% for GI hemorrhage [26][27][28]. We interpret this as supportive evidence, as demonstrated by other investigators [16], that fellowship training does not adversely impact the CRO of the mentor program and that the MI safely absorbed the learning curves of the FGs without compromising patient care in this study.…”

Section: Discussionmentioning

confidence: 99%

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Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass

et al. 2009

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Background The concept that advanced surgical training can reduce or eliminate the learning curve for complex procedures makes logical sense but is difficult to verify and has not been tested for laparoscopic Roux-en-Y gastric bypass (LRYGB). We sought to determine if minimally invasive/bariatric surgery fellowship graduates (FGs) would demonstrate complication-related outcomes (CRO) equivalent to the outcomes achieved during their training experience under the supervision of experienced bariatric surgeons. Methods We compared CRO for the first 100 consecutive LRYGBs performed in practice by five consecutive minimally invasive/bariatric fellows at new institutions (total 500 cases) to CRO for the 611 consecutive LRYGBs performed during their fellowship training experience under the supervision of three experienced bariatric surgeons at the host training institution. Results The two patient groups did not differ demographically. The 18 types of major and minor complications identified after LRYGB did not differ among the five fellowship graduates. The mentors' CRO were compatible with published benchmark data. As compared with the training institution data, the overall incidence of complications for the combined experience of fellowship graduates did not differ statistically from that of the mentors. The fellowship graduates' early experience included zero nongastrojejunostomy leaks (0% versus 1.5%) and a low rate of anastomotic stricture (0.8% versus 3.0%), incisional hernia (1% versus 4.4%), bowel obstruction (0% versus 3%), wound infection (0.3% versus 3.1%), and gastrointestinal hemorrhage (0.2% versus 1.6%). The rate of gastrojejunostomy leak (1.8% versus 2.6%) and, most importantly, mortality (0.8% versus 0.7%) did not differ between the two groups. Conclusions Fellowship graduates achieved high-quality surgical outcomes from the very beginning of their postfellowship practices, which are comparable to those of their experienced mentors. These data validate the concept that advanced surgical training can eliminate the learning curve often associated with complex minimally invasive procedures, specifically LRYGB.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass

et al. 2009

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“…Lower productivity and higher health care costs resulting from obesity and its comorbidities have led to proposals for governmental intervention [6][7][8][9][10]. Methods for quantifying the costs of obesity costs and the benefits of treatment remain controversial [11][12][13]. Nonetheless, it is well established that about 10% of health care dollars are devoted to obesity treatment, which is economically justified by the increased absenteeism and decreased productivity associated with this disorder [14][15][16][17][18][19].…”

mentioning

confidence: 99%