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Does High Volume Bariatric Surgery Fellowship Training Affect Laparoscopic Roux-en-Y Gastric Bypass Outcomes?
Liam A Haveran, Joshua Felsher, Josh Hill, Vera Freeman, Donald Czerniach, Richard Perugini, Stephen Baker, John Kelly
UMass Memorial Medical Center, Worcester, MA
Objective: Laparoscopic gastric bypass is a technically difficult procedure associated with a steep learning curve. It follows that the learning curve may be shorter for surgeons who have completed formal fellowship training in laparoscopic gastric bypass surgery.
Design: Retrospective study.
Setting: Tertiary care academic center.
Patients: The first 120 consecutive morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass surgery by 3 different surgeons. Surgeon 1 completed laparoscopic fellowship program which did not include Bariatric surgery. Surgeons 2 and 3 completed fellowship training with an emphasis on bariatric surgery.
Interventions: Laparoscopic Roux-en-Y gastric bypass.
Main Outcome Measures: Perioperative and postoperative outcomes and complications within the first year.
Results: Operative time decreased significantly faster for surgeons 2 and 3 when compared to surgeon 1 (p < 0.01). Both surgeons 2 and 3 had no mortalities within the first 120 cases, whereas surgeon 1 had 2 (1.7%) mortalities. Mean length of stay was significantly shorter for surgeons 2 and 3 than for surgeon 1 (3.3 vs 4.0 vs 4.2 days, p < 0.01). Total complication rates were significantly less for surgeons 2 and 3 when compared to surgeon 1 (17.5% vs 15% vs 59.2%, p < 0.01). Reoperation rates were not significantly different amongst surgeons.
Conclusions: Two Surgeons with fellowship training in laparoscopic Roux-en-Y gastric bypass surgery had significantly less complications and a shorter learning curve when compared to a surgeon without formal bariatric training. These 3 surgeons represent a small cross section of the bariatric surgery community and a more broad based study is necessary to confirm these findings.
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