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

Mohamed R. Ali, David S. Tichansky, Shanu N. Kothari, Corrigan L McBride, Adolfo Z. Fernandez, Harvey J. Sugerman, John M. Kellum, Luke G. Wolfe, Eric J. Demaria

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)138-144
Number of pages7
JournalSurgical endoscopy
Volume24
Issue number1
DOIs
StatePublished - Jan 2010

Fingerprint

Learning Curve
Bariatric Surgery
Gastric Bypass
Minimally Invasive Surgical Procedures
Bariatrics
Mentors
Benchmarking
Gastrointestinal Hemorrhage
Wound Infection
Pathologic Constriction
Mortality
Incidence

Keywords

  • Bariatric surgery
  • Fellowship training
  • Gastric bypass
  • Laparoscopy
  • Minimally invasive surgery
  • Obesity

ASJC Scopus subject areas

  • Surgery

Cite this

Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass. / Ali, Mohamed R.; Tichansky, David S.; Kothari, Shanu N.; McBride, Corrigan L; Fernandez, Adolfo Z.; Sugerman, Harvey J.; Kellum, John M.; Wolfe, Luke G.; Demaria, Eric J.

In: Surgical endoscopy, Vol. 24, No. 1, 01.2010, p. 138-144.

Research output: Contribution to journalArticle

Ali, Mohamed R. ; Tichansky, David S. ; Kothari, Shanu N. ; McBride, Corrigan L ; Fernandez, Adolfo Z. ; Sugerman, Harvey J. ; Kellum, John M. ; Wolfe, Luke G. ; Demaria, Eric J. / Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass. In: Surgical endoscopy. 2010 ; Vol. 24, No. 1. pp. 138-144.
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AU - Kothari, Shanu N.

AU - McBride, Corrigan L

AU - Fernandez, Adolfo Z.

AU - Sugerman, Harvey J.

AU - Kellum, John M.

AU - Wolfe, Luke G.

AU - Demaria, Eric J.

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N2 - 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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