The Preceding Surgeon Factor in Bariatric Surgery: a Positive Influence on the Learning Curve of Subsequent Surgeons

Geubbels, Noëlle; Brauw, L. M. de; Acherman, Yaïr I. Z.; Laar, Arnold van de; Wouters, Michel W. J. M.; Bruin, Sjoerd C.

doi:10.1007/s11695-014-1538-x

Cited by 36 publications

(23 citation statements)

References 22 publications

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“…Prevention of distal stenosis: Several publications [28,29] have advocated the importance of the learning curve for different bariatric procedures in order to diminish the postoperative complication rate. It is important to select the appropriate stapler load to minimize the issue of stapler malformation or failure.…”

Section: Preventionmentioning

confidence: 99%

Prevention and Management of Staple Line Leaks after Laparoscopic Sleeve Gastrectomy

Botaitis¹,

Mitsala²,

Perente³

et al. 2018

JAS

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Laparoscopic Sleeve Gastrectomy (LSG) is gaining ground as a bariatric procedure with proven efficacy on weight loss and obesity-related comorbidities. Compared to other bariatric procedures, its complications can be even more severe. Gastric leak is estimated to be the most serious complication of this procedure due to difficult healing processes not to mention the fact that it may also be responsible for local or general severe septic complications. Staple line dehiscence and subsequent leaks following sleeve gastrectomy are not very frequent but are a difficult complication that can also become chronic. Various options have been suggested but no definitive has been established. The management of patients who develop leakages requires a multidisciplinary team. Choosing the proper approach depends on the clinical condition of the patient and the onset time of leak. Main aim of this paper is to provide an overview of the pathogenic and promoting factors of staple line leak following LSG on the basis of recent literature review and to report the evidence based preventive measures and treatment solutions of this life-threatening complication.

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Section: Preventionmentioning

confidence: 99%

Prevention and Management of Staple Line Leaks after Laparoscopic Sleeve Gastrectomy

Botaitis¹,

Mitsala²,

Perente³

et al. 2018

JAS

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“…Over the course of years, some modifications have been made to our surgical technique. These have been described elsewhere [41]. Postoperatively, all patients received thromboprophylaxis subcutaneously.…”

Section: Validation Cohortmentioning

confidence: 99%

Risk Stratification Models: How Well do They Predict Adverse Outcomes in a Large Dutch Bariatric Cohort?

et al. 2015

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The overall majority of the included risk models are unsuitable for risk prediction. Only one model with an emphasis on surgeon- and center-related factors instead of patient-related factors predicted adverse outcome correctly in our external validation cohort. These findings support the establishment of specialty centers and warn benchmark data institutions not to correct bariatric outcome data by any other patient-related factor than age.

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“…These studies confirm the inverse relationship between surgeon experience and operative time and the indirect extrapolation to surgical proficiency; however, training and teaching laparoscopic skills involves complex surgical decision making and a rapidly changing intraoperative dynamic that involve a broad set of metrics. A number of recent studies corroborate that the LC and incidence of postoperative complications for a variety of laparoscopic procedures is highly correlated to hospital and attending surgeon volume and experience .…”

Section: Discussionmentioning

confidence: 86%

Defining the Tipping Point in Surgical Performance for Laparoscopic Donor Nephrectomy Among Transplant Surgery Fellows: A Risk-Adjusted Cumulative Summation Learning Curve Analysis

Serrano

Bangdiwala

Vock

et al. 2017

American Journal of Transplantation

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The United Network for Organ Sharing recommends that fellowship‐trained surgeons participate in 15 laparoscopic donor nephrectomy (LDN) procedures to be considered proficient. The American Society of Transplant Surgeons (ASTS) mandates 12 LDNs during an abdominal transplant surgery fellowship. We performed a retrospective intraoperative case analysis to create a risk‐adjusted cumulative summation (RACUSUM) model to assess the learning curve of novice transplant surgery fellows (TSFs). Between January 2000 and December 2014, 30 novice TSFs participated in the organ procurement rotation of our ASTS‐approved abdominal transplant surgery fellowship. Measures of surgical performance included intraoperative time, estimated blood loss, and incidence of intraoperative complications. The performance of senior TSFs was used to benchmark novice TSF performance. Scores were tabulated in a learning curve model, adjusting for case complexity and prior TSF case volume. Rates of adverse surgical events were significantly higher for novice TSFs than for senior TSFs. In univariable analysis, multiple renal arteries, high BMI, prior abdominal surgery, male donor, and nephrolithiasis were correlated with higher incidence of adverse surgical events. Based on the RACUSUM model, high intraoperative time is mitigated after 28 procedures, incidence of intraoperative complications tends to diminish after 24 procedures, and improvement in estimated blood loss did not remain consistent. TSFs exhibit a tipping point in LDN performance by 24–28 cases and proficiency by 35–38 cases.

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The Preceding Surgeon Factor in Bariatric Surgery: a Positive Influence on the Learning Curve of Subsequent Surgeons

Cited by 36 publications

References 22 publications

Prevention and Management of Staple Line Leaks after Laparoscopic Sleeve Gastrectomy

Prevention and Management of Staple Line Leaks after Laparoscopic Sleeve Gastrectomy

Risk Stratification Models: How Well do They Predict Adverse Outcomes in a Large Dutch Bariatric Cohort?

Defining the Tipping Point in Surgical Performance for Laparoscopic Donor Nephrectomy Among Transplant Surgery Fellows: A Risk-Adjusted Cumulative Summation Learning Curve Analysis

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