Does establishing a bariatric surgery fellowship training program influence operative outcomes?

BACKGROUND

Roux-en-Y gastric bypass (RYGB) has a long learning curve that may be reflected in operative outcomes. This study sought to assess whether training a fellow has an impact on the operative outcomes of the training program.

METHODS

Prospectively collected data on 150 consecutive patients were compared before (group 1) and after (group 2) establishment of a fellowship-training program.

RESULTS

A greater number of patients underwent laparoscopic RYGB (LRYGB) in group 2 than in group 1 (63% vs 46%; p = 0.01). The group 2 patients were similar to the group 1 patients in terms of age, gender, length of stay, and complication rate. However, they had a higher body mass index (BMI) (median 50 kg/m2; range, 39-64 kg/m2 vs median, 46 kg/m2; range, 38-56 kg/m2; p = 0.01) and a higher incidence of prior abdominal procedures (21% vs 7%; p = 0.006). In addition, operative time was significantly shorter for the patients who underwent open RYGB (ORYGB) (median, 150 min; range, 65-280 min vs median, 110 min; range, 50-210 min; p < 0.001) and LRYGB (median, 202 min; range, 105-450 min vs median, 134 min; range, 50-191 min; p < 0.001) in group 2 than for the patients in group 1. The patients who underwent ORYGB in groups 1 and 2 had similar characteristics and outcomes. Increasing experience with both ORYGB and LRYGB correlated with a decrease in operative times for group 2 (p < 0.001), but not for group 1.

CONCLUSION

Establishment of a fellowship program shortens the operative times for both open and laparoscopic RYGB and expands the scope of bariatric practice by compounding the experience of the operating team without increasing complications.

Modulation of 75S RNA synthesis in the Balbiani rings of Chironomus tentans with galactose treatment

Galactose has been used as a tool to modify gene activity in the giant puffs Balbiani ring 2 (BR2) and Balbiani ring 1 (BR1) on chromosome IV in the salivary glands of Chironomus tentans. BR2 decreased gradually and was absent or almost absent after a four day galactose treatment. Concomitant with this morphological change, the labelling of the population of growing 75S RNA molecules in BR2 decreased, and was essentially abolished after four days in galactose. Since the elongation rate at the 75S RNA genes proved to be the same in the galactose treated glands as in the control glands, the decreased labelling in BR2 was likely to correspond to a decreased production of 75S RNA. No changes in the size distribution of the growing 75S RNA molecules were noted during the galactose treatment, suggesting that the modulation of the activity was most likely accomplished at the initiation level, but regulation of a very early premature termination could not be excluded. When galactose was removed from the medium, BR2 attained its normal size and its ordinary RNA labelling. BR1 was studied in parallel with BR2 and it behaved strikingly different: BR1 expanded during the galactose treatment and the amount of growing 75S RNA increased, indicating an enhanced production of this 75S RNA species. Also the modulation of BR1 RNA synthesis was reversible. During the galactose treatment no changes in the labelling of chromosome I-III and of nucleolar RNA were observed suggesting that during the four day treatment, galactose exerted its effect mainly on the synthesis of BR2 and BR1 transcription products. The significance of these observations are considered in relation to the information available on the synthesis of the corresponding secretory polypeptides and the formation of the tube-like burrows. We also discuss the implications of the results for models of the regulation of gene activity and of the puffing process.