Establishing laparoscopic Roux-en-Y gastric bypass: perioperative outcome and characteristics of the learning curve.

Søvik, Torgeir T; Aasheim, Erlend T; Kristinsson, Jon; Schou, Carl Fredrik; Diep, Lien My; Nesbakken, Arild; Mala, Tom

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.