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Zimmerman A, Bhimani N, Chan P, Mitchell D, Leibman S, Smith G. Initial experience with laparoscopic gastric bypass in an Australian general foregut surgery unit. ANZ J Surg 2023; 93:2857-2863. [PMID: 37658592 DOI: 10.1111/ans.18673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/31/2023] [Accepted: 08/12/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Laparoscopic gastric bypass (LGB) is an increasingly utilized approach to bariatric surgery in Australia. A high proportion of those procedures are revisional due to Australia's legacy of laparoscopic adjustable gastric banding (LAGB), which is not the case internationally. The aim of this study was to compare post-operative outcomes in an Australian general foregut surgery unit against benchmarks published in the literature. METHODS This is retrospective cohort study of morbidly obese patients undergoing primary or revisional laparoscopic Roux-en-Y gastric bypass (RYGB) or laparoscopic one anastomosis gastric bypass (OAGB) with the two senior authors between 5 May 2015 and 27 June 2019. Perioperative data for the unit's first 100 cases were collected prospectively, stored on a unit database and analysed. Post-operative complications at 30 days, 90 days, mortality, length of hospital stay, and Defined Adverse Events were chosen as indicators of the perioperative outcome (as defined in the Monash Bariatric Surgery Registry). RESULTS In this cohort, 35% of procedures were RYGB and 65% were OAGB. The majority (58%) were revisional procedures. Most patients (74%) were female. The median age was 50. The comorbidity profile of the population was similar to those published internationally. The median hospital stay was 4 days. There was no mortality. Early complications occurred in 9% of patients, with 3% occurring late. CONCLUSION Outcomes of our first 100 cases are comparable with those recorded in the literature, notwithstanding a much higher proportion of revisional cases. LGB can be safely introduced in Australian general foregut surgery units by experienced laparoscopic surgeons.
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Affiliation(s)
- Andrew Zimmerman
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Nazim Bhimani
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Faculty of Health and Medicine, University of Sydney, New South Wales, Australia
| | - Priscilla Chan
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Cancer Research Division, Cancer Council New South Wales, New South Wales, Australia
| | - David Mitchell
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Steven Leibman
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Garett Smith
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Northern Clinical School, University of Sydney, New South Wales, Australia
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Development and Validity of a Novel Ex Vivo Porcine Organs Laparoscopic Roux-en-Y Gastric Bypass Training Model. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03639-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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3
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Stenberg E, Dos Reis Falcão LF, O'Kane M, Liem R, Pournaras DJ, Salminen P, Urman RD, Wadhwa A, Gustafsson UO, Thorell A. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update. World J Surg 2022; 46:729-751. [PMID: 34984504 PMCID: PMC8885505 DOI: 10.1007/s00268-021-06394-9] [Citation(s) in RCA: 133] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 02/08/2023]
Abstract
Background This is the second updated Enhanced Recovery After Surgery (ERAS®) Society guideline, presenting a consensus for optimal perioperative care in bariatric surgery and providing recommendations for each ERAS item within the ERAS® protocol. Methods A principal literature search was performed utilizing the Pubmed, EMBASE, Cochrane databases and ClinicalTrials.gov through December 2020, with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. After critical appraisal of these studies, the group of authors reached consensus regarding recommendations. Results The quality of evidence for many ERAS interventions remains relatively low in a bariatric setting and evidence-based practices may need to be extrapolated from other surgeries. Conclusion A comprehensive, updated evidence-based consensus was reached and is presented in this review by the ERAS® Society.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | | | - Mary O'Kane
- Dietetic Department, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Ronald Liem
- Department of Surgery, Groene Hart Hospital, Gouda, Netherlands.,Dutch Obesity Clinic, The Hague, Netherlands
| | - Dimitri J Pournaras
- Department of Upper GI and Bariatric/Metabolic Surgery, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, UK
| | - Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland.,Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anupama Wadhwa
- Department of Anesthesiology, Outcomes Research Institute, Cleveland Clinic, University of Texas Southwestern, Dallas, USA
| | - Ulf O Gustafsson
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anders Thorell
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, Stockholm, Sweden
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Wehrtmann FS, de la Garza JR, Kowalewski KF, Schmidt MW, Müller K, Tapking C, Probst P, Diener MK, Fischer L, Müller-Stich BP, Nickel F. Learning Curves of Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Bariatric Surgery: a Systematic Review and Introduction of a Standardization. Obes Surg 2021; 30:640-656. [PMID: 31664653 DOI: 10.1007/s11695-019-04230-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The most commonly performed bariatric procedures are laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (LSG). Impact of learning curves on operative outcome has been well shown, but the necessary learning curves have not been clearly defined. This study provides a systematic review of the literature and proposes a standardization of phases of learning curves for RYGB and LSG. METHODS A systematic literature search was performed using PubMed, Web of Science, and CENTRAL databases. All studies specifying a number or range of approaches to characterize the learning curve for RYGB and LSG were selected. RESULTS A total of 28 publications related to learning curves for 27,770 performed bariatric surgeries were included. Parameters used to determine the learning curve were operative time, complications, conversions, length of stay, and blood loss. Learning curve range was 30-500 (RYGB) and 30-200 operations (LSG) according to different definitions and respective phases of learning curves. Learning phases described the number of procedures necessary to achieve predefined skill levels, such as competency, proficiency, and mastery. CONCLUSIONS Definitions of learning curves for bariatric surgery are heterogeneous. Introduction of the three skill phases competency, proficiency, and mastery is proposed to provide a standardized definition using multiple outcome variables to enable better comparison in the future. These levels are reached after 30-70, 70-150, and up to 500 RYGB, and after 30-50, 60-100, and 100-200 LSG. Training curricula, previous laparoscopic experience, and high procedure volume are hallmarks for successful outcomes during the learning curve.
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Affiliation(s)
- F S Wehrtmann
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - J R de la Garza
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - K F Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - M W Schmidt
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - K Müller
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - C Tapking
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - P Probst
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - M K Diener
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - L Fischer
- Department of Surgery, Hospital Mittelbaden, Balger Strasse 50, 76532, Baden-Baden, Germany
| | - B P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Lo HC. The learning curve of one anastomosis gastric bypass and its impact as a preceding procedure to Roux-en Y gastric bypass: initial experience of one hundred and five consecutive cases. BMC Surg 2020; 20:37. [PMID: 32101137 PMCID: PMC7045633 DOI: 10.1186/s12893-020-00697-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/13/2020] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this study was to assess the learning curve of one anastomosis gastric bypass (OAGB-MGB) at the start of a low volume bariatric unit and analyze its impact as a preceding procedure to Roux-en Y gastric bypass (RYGB). Methods From January 2014 to December 2017, all patients who underwent bariatric surgeries in our teaching hospital that were performed by the same surgeon were enrolled. The first 47 patients who underwent OAGB-MGB were assigned to group A. RYGB has been offered as a treatment option since July 2016; thereafter, 26 patients who underwent OAGB-MGB and 32 patients who underwent RYGB at the same time interval were assigned to group B and group C, respectively. Baseline characteristics, perioperative outcomes and percentage of total weight loss (%TWL) up to 12 months postoperatively were collected and analyzed between groups. Results Compared to the patients in group C, those in groups A and B were older (39.4 yrs. and 42.2 yrs., respectively, vs. 34.2 yrs.; p = 0.021) and predominantly male (48.9 and 73.1%, respectively vs. 40.6%; p = 0.04), and they had a higher body mass index (41.8 kg/m2 and 43.3 kg/m2, respectively vs. 37.7 kg/m2; p = 0.002) and a higher incidence of hypertension (44.7 and 61.5%, respectively vs. 21.9%; p = 0.008). In addition, the operation time was significantly reduced (118.2 min and 115.8 min, respectively vs. 153.1 min; p < 0.001), and the length of stay was shortened (3.0 days and 2.9 days, respectively vs. 3.4 days; p = 0.002) in groups B and C compared to group A. No mortality, conversion or leakage was reported throughout the study period. The 30-day complication rate was decreased in group C compared to groups A and B (0% vs. 6.4 and 7.7%, respectively; p = 0.307). The %TWL at the 12-month follow-up was 36.3, 30.9 and 28.3% for groups A, B and C, respectively (p < 0.001). Conclusion Our study verified the early emergence of a learning curve effect for OAGB-MGB, and the proficiency acquired can be transferred to subsequent practice for RYGB in terms of acceptable operation time and length of stay without an increase in complications.
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Affiliation(s)
- Hung-Chieh Lo
- Division of Trauma and Emergency Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan, Republic of China. .,School of Medicine, College of Medicine, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan, Republic of China.
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6
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Wolter S, Duprée A, ElGammal A, Runkel N, Heimbucher J, Izbicki JR, Mann O, Busch P. Mentorship Programs in Bariatric Surgery Reduce Perioperative Complication Rate at Equal Short-Term Outcome-Results from the OPTIMIZE Trial. Obes Surg 2020; 29:127-136. [PMID: 30187421 DOI: 10.1007/s11695-018-3495-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to determine the efficacy of coaching on outcome in low volume centers of excellence and to evaluate the influence of mentorship programs on the center development. BACKGROUND The number of bariatric procedures has increased steadily in the last years. Providing nationwide bariatric care on a high professional level needs structures to train and guide upcoming centers and ensure high quality in patient care. METHODS A prospective multicentered, observational study including laparoscopic sleeve gastrectomies (SG) and Roux-en-Y gastric bypass (RYGB) procedures was performed. Twelve emerging bariatric centers were coached by five experienced bariatric centers. Surgeons of the mentor centers gave guidance on pre- and postsurgical management of their patients including complications and proctored the first interventions. The results were compared regarding operative outcomes, percentage of excess weight loss, complications, and resolution of comorbidities. RESULTS A total of 214 of 293 patients (73.0%) completed the study. The most frequently reported complications were wound infection (4.4%), disorder of emptying stomach/new reflux (2.4%), anastomotic leaks, intra-abdominal secondary hemorrhage, and dumping syndrome (2.0% each). The mortality rate was zero. We found no difference in overall complication rates or resolution of obesity-related comorbidities when comparing experienced surgeons with less experienced surgeons. CONCLUSIONS Our results suggest that under the conditions of the practices of this study, coaching and mentoring were associated with comparable outcomes both in experienced and emerging centers. In addition, mentorship programs ensure equal outcome quality in terms of improvement of obesity-associated comorbidities. TRIAL REGISTRATION NCT Number: NCT01754194 .
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Affiliation(s)
- Stefan Wolter
- Department of General-, Visceral- and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Anna Duprée
- Department of General-, Visceral- and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Alexander ElGammal
- Department of General-, Visceral- and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Norbert Runkel
- Department of General- and Visceral Surgery, Schwarzwald Baar Hospital, Villingen-Schwenningen, Germany
| | | | - Jakob R Izbicki
- Department of General-, Visceral- and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Oliver Mann
- Department of General-, Visceral- and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Philipp Busch
- Department of General-, Visceral- and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Abstract
BACKGROUND Improvement of dyslipidemia is an important benefit of bariatric surgery. The benefits of laparoscopic sleeve gastrectomy (LSG) among dyslipidemia are still a matter of debate. METHODS We conducted a retrospective descriptive study between 2010 and 2013. Obese patients undergoing LSG, with recorded dyslipidemia at admission and a follow-up for at least 1 year, were included for analysis. Demographic characteristics, medication in use, and a complete lipid profile were collected before surgery. After surgery, weight was controlled at 1, 3, 6, and 12 months. Lipid profile was re-evaluated 1 year after surgery. Patients were divided according to weight loss into two groups: (A) adequate weight loss and (B) inadequate weight loss. Lipid profile evolution was then compared between groups. RESULTS One hundred seven patients met the inclusion criteria. Pre-op mean BMI was 45.13 ± 7.5 kg/m2. One year after LSG, mean BMI was 30.6 ± 7.1 kg/m2 with a change in BMI of 11.5 ± 6.6 kg/m2, a %TWL of 26.9 ± 13.5%, and a %EWL of 60.3 ± 36.6%. Hypercholesterolemia and hypertriglyceridemia remission was achieved in 45 and 86% of the patients and improved in another 19 and 4% respectively. Seventy-four percent improved HDL levels. LDL levels improved in 39% and remitted in 37%. Medication was discontinued in 43.7%. HDL increase and LDL, TG, and non-HDL-C decrease were significantly greater in group A. CONCLUSIONS LSG produces an improvement in lipid profile, with a significant increase in HDL and a decrease in LDL, triglycerides, and non-HDL-C.
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Sun TM, Lee HE, Lan TH. The influence of dental experience on a dental implant navigation system. BMC Oral Health 2019; 19:222. [PMID: 31623636 PMCID: PMC6798373 DOI: 10.1186/s12903-019-0914-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study evaluated the operating performance of an implant navigation system used by dental students and dentists of prosthodontic background with varying levels of experience. A surgical navigation system and optical tracking system were used, and dentists’ accuracies were evaluated in terms of differences between the positions of actually drilled holes and those of the holes planned using software before surgeries. Methods The study participants were 5 dental students or dentists who had studied in the same university and hospital but had different experience levels regarding implants. All participants were trained in operating the AqNavi system in the beginning of the study. Subsequently, using 5 pairs of dental models, each participant drilled 5 implant holes at 6 partially edentulous positions (11, 17, 26, 31, 36, and 47). In total, each participant conducted 30 drilling tests. Results In total, 150 tests among 5 dentists at 6 tooth positions (11, 17, 26, 31, 36, and 47) were conducted. Although a comparison of the tests revealed significant differences in the longitudinal error (P < .0001) and angular error (P = .0011), no significant difference was observed in the total error among the dentists. Conclusions A relatively long operating time was associated with relatively little implant experience. Through the dental navigation system, dental students can be introduced to dental implant surgery earlier than what was possible in the past. The results demonstrated that the operational accuracy of the dental implant navigation system is not restricted by participants’ implant experience levels. The implant navigation system assists the dentist in the ability to accurately insert the dental implant into the correct position without being affected by his/her own experience of implant surgery.
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Affiliation(s)
- Ting-Mao Sun
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, 100 Shin-Chuan 1st Road, Sanmin District, Kaohsiung, 80708, Taiwan
| | - Huey-Er Lee
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, 100 Shin-Chuan 1st Road, Sanmin District, Kaohsiung, 80708, Taiwan.,Division of Family Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ting-Hsun Lan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, 100 Shin-Chuan 1st Road, Sanmin District, Kaohsiung, 80708, Taiwan. .,Division of Prosthodontics, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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The Preceding Surgeon Factor in Bariatric Surgery: a Positive Influence on the Learning Curve of Subsequent Surgeons. Obes Surg 2016; 25:1417-24. [PMID: 25511752 DOI: 10.1007/s11695-014-1538-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The learning curve of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery has been well investigated. The learning curve is defined by complications and/or by duration of surgery (DOS). Previous studies report an inverse relationship between patient outcome and patient volume. In this study, we investigate whether the learning curve of preceding bariatric surgeons is of additional influence for surgeons who start to perform LRYGB in the same centre. MATERIALS AND METHODS We retrospectively analysed the records of all 713 consecutive primary LRYGB patients operated in our centre from December 2007 until July 2012. Surgeon 1 and 3 had previous laparoscopic bariatric experience whilst Surgeon 2 and 4 had not. We stratified the data between the four surgeons with different levels of experience and in a chronology of 50 cases. RESULTS Sixty-seven (9.4 %) complications occurred in the study period. Surgeon 1 had more complications occurring within the first 50 cases than Surgeon 4 (10 versus 1, p < 0.05). There was no difference in complication rate between groups of 50 consecutive cases. None of the patients died. DOS decreased for every consecutive surgeon, irrespective of their experience. The learning curve defined by DOS was steepest for Surgeon 1, followed by Surgeon 2, 3 and 4. CONCLUSION In this study, we show that the learning curve of the preceding surgeon positively influences the learning curve of latter surgeons, irrespective of their experience. Therefore, the 'preceding surgeon factor' should be taken in account in addition to volume requirements when starting new bariatric facilities.
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Management of staple line leaks after sleeve gastrectomy in a consecutive series of 378 patients. Surg Laparosc Endosc Percutan Tech 2015; 25:89-93. [PMID: 24752161 DOI: 10.1097/sle.0000000000000026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is gaining acceptance as a stand-alone bariatric procedure with proven efficacy on weight loss and obesity-related comorbidities. A specific and potentially severe complication of LSG is the staple line leak (SLL). Our aim was to report the SLL rate and its management in a prospective cohort of 378 LSGs. PATIENTS AND METHODS A total of 378 patients underwent LSG from July 2005 to July 2011. The gastric transection was performed by an initial 60 mm firing of 4.5 mm staples at the antrum and successive 60 mm firings of 3.5 mm staples at the gastric body and fundus toward the left diaphragmatic crus. A 36 Fr bougie was used to calibrate the gastric tube. The staple line was systematically reinforced with a partial-thickness running suture. RESULTS The overall complications and SLL rate were 20/378 (5.29%) and 9/378 (2.38%), respectively. SLLs were managed by laparoscopic (n=2) or open (n=1) exploration, drainage and endoscopic self-expandable covered stent, computed tomography-guided percutaneous drainage (n=2), or a self-expandable covered stent alone (n=4). Medical support including total parenteral nutrition and adapted antibiotics was started in all patients. The combined treatment modalities were successful in all cases. CONCLUSIONS SLL was the most common complication of LSG accounting for half of the overall complications. Percutaneous drainage and self-covered stents combined with antibiotics and parenteral nutrition are effective for SLL and should be proposed as first-line treatment in stable patients.
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12
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Zellmer JD, Mathiason MA, Kallies KJ, Kothari SN. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg 2014; 208:903-10; discussion 909-10. [DOI: 10.1016/j.amjsurg.2014.08.002] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/05/2014] [Accepted: 08/11/2014] [Indexed: 02/07/2023]
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Vix M, Diana M, Liu KH, D'Urso A, Mutter D, Wu HS, Marescaux J. Evolution of glycolipid profile after sleeve gastrectomy vs. Roux-en-Y gastric bypass: results of a prospective randomized clinical trial. Obes Surg 2013. [PMID: 23207829 DOI: 10.1007/s11695-012-0827-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study aims to report glycolipid changes after sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) in the setting of a prospective randomized clinical trial. METHODS One hundred patients were randomly assigned to RYGB (n = 45) and SG (n = 55). Fasting glucose, insulin, glycated hemoglobin (HbA1c%), triglycerides, and serum cholesterol (total, HDL, and LDL) were evaluated at inclusion and after 1, 3, 6, and 12 months. The index for homeostasis model assessment of insulin resistance (HOMA-IR) and β cell function (HOMA-B) were assessed. RESULTS Mean postoperative 1-, 3-, 6-, and 12-month excess weight loss was 25.39, 43.47, 63.75, and 80.38 % after RYGB and 25.25, 51.32, 64.67, and 82.97 % after SG, respectively. Mean fasting glucose and fasting serum insulin were similarly and statistically significantly reduced in both RYGB and SG. Mean HOMA-IR improved in both groups, particularly in case of high preoperative values, and mean HOMA-B improved at 1 year after RYGB. HbA1c% dropped from 5.66 % (SD = 0.61) to 5.57 % (SD = 0.32) after RYGB and from 5.64 % (SD = 0.43) to 5.44 % (SD = 0.43) after SG. Total cholesterol was significantly higher at 1 month (p = 0.04), 3 months (p = 0.03), and 1 year (p = 0.005) after SG as compared to RYGB. LDL cholesterol decreased significantly after RYGB at 1 month (p = 0.03), 3 months (p = 0.0001), and 1 year (p = 0.0004) as compared to SG. HDL cholesterol was increased at 1 year in the RYGB group but not in the SG group. Triglycerides decreased similarly in both groups. CONCLUSIONS Short-term glycemic control was comparable after SG and RYGB. An improved lipid profile was noted after RYGB in patients with abnormal preoperative values.
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Affiliation(s)
- Michel Vix
- IRCAD-IHU, University of Strasbourg, Strasbourg, France.
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14
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Giannotti D, Patrizi G, Casella G, Di Rocco G, Marchetti M, Frezzotti F, Bernieri MG, Vestri AR, Redler A. Can virtual reality simulators be a certification tool for bariatric surgeons? Surg Endosc 2013; 28:242-8. [PMID: 23996341 PMCID: PMC3889499 DOI: 10.1007/s00464-013-3179-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/08/2013] [Indexed: 12/12/2022]
Abstract
Background Construct validity of virtual laparoscopic simulators for basic laparoscopic skills has been proposed; however, it is not yet clear whether the simulators can identify the actual experience of surgeons in more complex procedures such as laparoscopic Roux-en-Y gastric bypass. This study tested the ability of the Lap Mentor simulator to recognize the experience in advanced laparoscopic procedures and to assess its role in the certification of bariatric surgeons. Methods Twenty surgeons were divided into two groups according to their experience in laparoscopic and bariatric surgery. The general group included 10 general surgeons performing between 75 and 100 nonbariatric laparoscopic procedures. The bariatric group included 10 bariatric surgeons performing between 50 and 100 laparoscopic bariatric procedures. Participants were tested on the simulator in one basic task (task 1: eye–hand coordination) and in two tasks of the gastric bypass module (task 2: creation of the gastric pouch; task 3: gastrojejunal anastomosis). Results Comparing the groups, no significant differences were found in task 1. Analyzing the results from the gastric bypass module (bariatric vs. general), in task 2, significant differences (p < 0.05) were found in the median volume of the gastric pouch (21 vs. 48 cm3), in the percentage of fundus included in the pouch (8.4 vs. 29.4 %), in the complete dissection at the angle of His (10 vs. 3), and in safety parameters. In task 3, significant differences were found in the size and position of enterotomies. Conclusions The Lap Mentor may be proposed as a certification tool for bariatric surgeons because it also recognizes their specific skills in the technical details of the procedure that affect long-term results. Furthermore, the possibility of analyzing the performance in detail can help define areas where the surgeon is lacking. These findings indicate a potential role of the Lap Mentor in tailoring the training to maximize improvement.
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Affiliation(s)
- Domenico Giannotti
- Department of Surgical Sciences, Policlinico "Umberto I", "Sapienza" - University of Rome, Viale Regina Elena 324, 00161, Rome, Italy,
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Sánchez-Santos R, Ruiz de Adana JC. [The scientific societies and the lack of skills: a training programme in bariatric surgery]. Cir Esp 2013; 91:209-10. [PMID: 23537595 DOI: 10.1016/j.ciresp.2013.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/03/2013] [Accepted: 02/05/2013] [Indexed: 11/26/2022]
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Sánchez-Santos R, Estévez S, Tomé C, González S, Brox A, Nicolás R, Crego R, Piñón M, Masdevall C, Torres A. Training programs influence in the learning curve of laparoscopic gastric bypass for morbid obesity: a systematic review. Obes Surg 2012; 22:34-41. [PMID: 21455832 DOI: 10.1007/s11695-011-0398-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The makeup of a new surgical bariatric team may be associated with a higher number of postoperative complications due to the learning curve. The aim of this study was to evaluate the outcomes during the learning curve of laparoscopic gastric bypass (LGBP) depending on surgeons' training. A systematic approach was used to review studies from the Pubmed, Embase (Ovid), Cancer Lit, Biomes Central via Scirus, Current Contens (ISI), and Web of Science (SCI) databases. Two reviewers independently screened all titles/abstracts and included/excluded studies based on full copies of manuscripts. The outcomes included were: specific training of the surgeon, postoperative complications (leaks, occlusion, hemorrhage, pneumonia, etc.), mortality, and surgical technique. One reviewer put data onto an Excel spreadsheet. Statistical analysis was performed with weighted linear regression. We identified 448 citations, of which 120 abstract and 50 full-text publications were reviewed. Fourteen papers were selected. Data from 1,848 patients were included. Eighteen different surgeons were analyzed during their learning curve (including the first author of this study). Surgeons were divided into two groups: (1) without formal laparoscopic bariatric training (13 surgeons) and (2) with formal laparoscopic bariatric training (five surgeons). Postoperative complications were more frequent in group 1: 18.1% (± 7.6) vs. 7.7% (± 1.96, p = 0.046); also, mortality was more frequent in group 1: 0.57% (± 0.87) vs. 0% (p = 0.05). An appropriated training in laparoscopic bariatric surgery contributes to a significant reduction in postoperative complications and mortality during the learning curve of LGBP.
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Affiliation(s)
- Raquel Sánchez-Santos
- Servicio de Cirugía General y Digestiva, Complejo Hospitalario Pontevedra, Pontevedra, Spain.
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Sommer T, Larsen JF, Raundahl U. Eliminating Learning Curve–Related Morbidity in Fast Track Laparoscopic Roux-en-Y Gastric Bypass. J Laparoendosc Adv Surg Tech A 2011; 21:307-12. [DOI: 10.1089/lap.2010.0569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Freeman L, Rahmani EY, Burgess RCF, Al-Haddad M, Selzer DJ, Sherman S, Constable P. Evaluation of the learning curve for natural orifice transluminal endoscopic surgery: bilateral ovariectomy in dogs. Vet Surg 2011; 40:140-50. [PMID: 21223315 DOI: 10.1111/j.1532-950x.2010.00779.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Study the learning curve for canine Natural Orifice Transluminal Endoscopic Surgery (NOTES) ovariectomy by evaluating operative times and complications. STUDY DESIGN Preclinical research study. ANIMALS Adult female dogs (n=20). METHODS NOTES ovariectomy procedures were performed as follows: Feasibility Group 1 (n=5), Feasibility Group 2 (n=5), and Early Clinical Group 3 (n=10). Six steps of the procedure were identified, timed separately, and the overall time was recorded from introduction to removal of the endoscope. Complications were recorded. Repeated measures analysis of variance using ranked data compared the effect of group (3 levels) on the time for each step. Nonlinear regression using an exponential model with nonzero asymptote was used to model the operative time-procedure number relationship. RESULTS Overall median operative time was significantly longer for Group 1 (195 minutes; range, 160-265 minutes) than Group 2 (108 minutes; range, 81-148 minutes; P=.048) and Group 3 (77 minutes; range, 41-136 minutes; P=.0008). The estimated asymptotic operative time was 71 minutes (95% confidence interval, 41-100 minutes); this time was reached after 10 procedures. Gastric cleansing and removing the left ovary took significantly longer in Group 1 than in Group 2 or 3. Operative complications included incomplete ovarian excision, dropping an ovary during retrieval, and conversion to an open procedure. No intraoperative complications occurred in Group 3. CONCLUSION NOTES procedures result in longer operative times in the early part of the learning curve and require considerable experience before reaching proficiency.
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Affiliation(s)
- Lynetta Freeman
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA.
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Three Hundred Laparoscopic Roux-en-Y Gastric Bypasses: Managing the Learning Curve in Higher Risk Patients. Obes Surg 2009; 20:290-4. [DOI: 10.1007/s11695-009-9914-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 06/24/2009] [Indexed: 10/20/2022]
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Hospital Discharge in the Day Following Open Roux-en-Y Gastric Bypass: Is it Feasible and Safe? Obes Surg 2008; 19:281-6. [DOI: 10.1007/s11695-008-9779-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 11/19/2008] [Indexed: 10/21/2022]
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Søvik TT, Aasheim ET, Kristinsson J, Schou CF, Diep LM, Nesbakken A, Mala T. Establishing laparoscopic Roux-en-Y gastric bypass: perioperative outcome and characteristics of the learning curve. Obes Surg 2008; 19:158-165. [PMID: 18566869 DOI: 10.1007/s11695-008-9584-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 05/23/2008] [Indexed: 01/14/2023]
Abstract
BACKGROUND Bariatric surgery was established at several Norwegian hospitals in 2004. This study evaluates the perioperative outcome and the learning curves for two surgeons while introducing laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS Morbidly obese patients undergoing primary LRYGB were included. Lengths of surgery and postoperative hospital stay, and 30-day rates of morbidity, reoperations, and readmissions were set as indicators of the learning curve. Learning effects were evaluated by graphical analyses and comparing the first and last 40 procedures for both surgeons. RESULTS The 292 included patients had a mean age of 40.0 +/- 9.5 years and a mean body mass index (BMI) of 46.7 +/- 5.3 kg/m(2). The mean length of surgery was 101 +/- 55 min. Complications occurred in 43 patients (14.7%), with no conversions to open surgery in the primary procedure and no mortality. Reoperations were performed in 14 patients (4.8%), of which five patients required open surgery. The median length of stay was 3 days (range 1-77), and 19 patients (6.5%) were readmitted. High patient age, but not high BMI, was associated with an increased risk of complication. For both surgeons, lengths of surgery and hospital stay were significantly reduced (p < 0.001), leveling out after 100 procedures. Reductions in the rates of morbidity, reoperations and readmissions were not found. CONCLUSION LRYGB was introduced with an acceptable morbidity rate and no mortality. Only the length of surgery and postoperative hospital stay were suitable indicators of a learning curve, which comprised about 100 cases.
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Affiliation(s)
| | - Erlend T Aasheim
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medicine, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway
| | - Jon Kristinsson
- Department of Gastrointestinal Surgery, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway
| | - Carl Fredrik Schou
- Department of Gastrointestinal Surgery, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway
| | - Lien My Diep
- Aker University Hospital Research Center, Trondheimsveien 235, 0514, Oslo, Norway
| | | | - Tom Mala
- Department of Gastrointestinal Surgery, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway
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