Overcoming the learning curve of laparoscopic Roux-en-Y gastric bypass: A 12-year experience

El-Kadre, Luciana; Tinoco, Augusto; Tinoco, Renam Catharina; Aguiar, Lívia; Santos, Tarciana Ribeiro

doi:10.1016/j.soard.2013.01.020

Cited by 47 publications

(27 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As a mixed procedure, RYGB has been considered by many the “gold standard” [18] and was in fact our procedure of choice during the open era and beginning of the laparoscopic one. Laparoscopic RYGB, however, is a technically demanding procedure with a relatively high morbidity and need for reoperations (especially during its steep learning curve) [19]. Weight regain (WR) has also been an issue found in series with a long-term FU [20].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients

Carbajo¹,

Luque-de-León²,

Jiménez³

et al. 2016

OBES SURG

286

157

View full text Add to dashboard Cite

BackgroundExcellent results have been reported with mini-gastric bypass. We adopted and modified the one-anastomosis gastric bypass (OAGB) concept. Herein is our approach, results, and long-term follow-up (FU).MethodsInitial 1200 patients submitted to laparoscopic OAGB between 2002 and 2008 were analyzed after a 6–12-year FU. Mean age was 43 years (12–74) and body mass index (BMI) 46 kg/m2 (33–86). There were 697 (58 %) without previous or simultaneous abdominal operations, 273 (23 %) with previous, 203 (17 %) with simultaneous, and 27 (2 %) performed as revisions.ResultsMean operating time (min) was as follows: (a) primary procedure, 86 (45–180); (b) with other operations, 112 (95–230); and (c) revisions, 180 (130–240). Intraoperative complications led to 4 (0.3 %) conversions. Complications prompted operations in 16 (1.3 %) and were solved conservatively in 12 (1 %). Long-term complications occurred in 12 (1 %). There were 2 (0.16 %) deaths. Thirty-day and late readmission rates were 0.8 and 1 %. Cumulative FU was 87 and 70 % at 6 and 12 years. The highest mean percent excess weight loss was 88 % (at 2 years), then 77 and 70 %, 6 and 12 years postoperatively. Mean BMI (kg/m2) decreased from 46 to 26.6 and was 28.5 and 29.9 at those time frames. Remission or improvement of comorbidities was achieved in most patients. The quality of life index was satisfactory in all parameters from 6 months onwards.ConclusionsLaparoscopic OAGB is safe and effective. It reduces difficulty, operating time, and early and late complications of Roux-en-Y gastric bypass. Long-term weight loss, resolution of comorbidities, and degree of satisfaction are similar to results obtained with more aggressive and complex techniques. It is currently a robust and powerful alternative in bariatric surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients

Carbajo¹,

Luque-de-León²,

Jiménez³

et al. 2016

OBES SURG

286

157

View full text Add to dashboard Cite

show abstract

“…Restricting independence during residency training may disadvantage recent residency graduates, fellowship programs, and patients because of a steepened learning curve during fellowship. Less autonomy during residency reduces recent graduates' ability to perform complex procedures independently as fellows . Academic faculty training the next generation of otolaryngologists must find a balance between adequately training residents and providing safe care for patients.…”

Section: Resultsmentioning

confidence: 99%

Graduating otolaryngology resident preparedness for fellowship as assessed by fellowship faculty

Highland

Cabrera‐Muffly

2017

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…Previous studies demonstrate a substantial learning curve before mastering laparoscopic gastric bypass. 1, 5, 13 It is unclear whether the same learning curve exists for laparoscopic sleeve gastrectomy. Between 2006 and 2013 there was rapid rise in the number of sleeve gastrectomy procedures in the state of Michigan.…”

Section: Discussionmentioning

confidence: 99%

Surgical skill in bariatric surgery: Does skill in one procedure predict outcomes for another?

Varban

Greenberg

Schram

et al. 2016

Surgery

View full text Add to dashboard Cite

STRUCTURED ABSTRACT Background Recent data establishes a strong link between peer video ratings of surgical skill and clinical outcomes with laparoscopic gastric bypass. Whether skill for one bariatric procedure can predict outcomes for another, related procedure is unknown. Methods Twenty surgeons voluntarily submitted videos of a standard laparoscopic gastric bypass procedure, which was blindly rated by 10 or more peers using a modified version of the Objective Structured Assessment of Technical Skills (OSATS). Surgeons were divided into quartiles for skill in performing gastric bypass and their outcomes within 30 days after sleeve gastrectomy were compared. Multivariate logistic regression analysis was utilized to adjust for patient risk factors. Results Surgeons with skill ratings in the top (n=5), middle (n=10, middle two combined), and bottom (n=5) quartiles for laparoscopic gastric bypass had similar rates of surgical and medical complications following laparoscopic sleeve gastrectomy (top 5.7%, middle 6.4%, bottom 5.5%, p=0.13). Furthermore, surgeon skill ratings did not correlate with rates of reoperation, readmission and emergency department visits. Top rated surgeons had significantly faster operating room times for sleeve gastrectomy (top 76 min, middle 90 min, bottom 88 min; p<0.001) and a higher annual volume of bariatric cases per year (top 240, middle 147, bottom 105; p=0.001). Conclusions Video ratings of surgical skill with laparoscopic gastric bypass do not predict outcomes with laparoscopic sleeve gastrectomy. Evaluation of surgical skill with one procedure may not apply to other related procedures and may require independent assessment of surgical technical proficiency.

show abstract

Overcoming the learning curve of laparoscopic Roux-en-Y gastric bypass: A 12-year experience

Cited by 47 publications

References 33 publications

Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients

Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients

Graduating otolaryngology resident preparedness for fellowship as assessed by fellowship faculty

Surgical skill in bariatric surgery: Does skill in one procedure predict outcomes for another?

Contact Info

Product

Resources

About