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Laparoscopic Roux-Y Gastric Bypass (LRYGBP): Results and Learning Curve of a High Volume Academic Program

Scott A Shikora
Tufts-New England Medical Center, Boston, MA

Objective: LRYGBP is a complex procedure performed on a high risk patient population. Good results can be attained with experience and volume.
Design: Retrospective study.
Setting:
Tertiary care academic hospital
Patients:
750 consecutive morbidly obese patients undergoing surgery from March 1998 to April 2004.
Interventions: All patients underwent LRYGBP.
Main Outcome Measures: Peri-operative deaths and complications.
Results: The patient population was 85% women and had a mean BMI of 47 kg/m2 (32-86). The overall complication rate was 15% and the mortality was 0.3%. For the first 100 cases, the complication rate was 26% with a mortality of 1%. The complication rate decreased to approximately 13% and was stable for the next 650 patients. The incidence of major complications has also decreased since the first 100 cases. Leak decreased from 3% to 1.1%. Thomboembolism from 1% to 0.6%. Overall mean operating time was 138 minutes (65-310). It decreased from 212 minutes for the first 100 cases to 132 minute for the next 650 and 105 minutes (65-200) for the last 100 cases.
Conclusions: LRYGBP is a technically difficult operation. This review of a large series in a high volume program demonstrated that the morbidity and mortality could be reduced by 50% with experience. The results are similar to those reported from other major centers. In addition, as reported elsewhere, the learning curve for this procedure may be 100 cases.

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