BACKGROUND:The literature reports that the learning curve for laparoscopic Roux-en-Y gastric bypass (LRYGBP) is approximately 75-100 cases. This aim of the present study was to evaluate the safety and feasibility of shortening the learning curve for performing LRYGBP by an experienced laparoscopic surgeon. METHODS:This study analyzed retrospectively the first 100 consecutive LRYGBP cases performed by an experienced laparoscopic surgeon between April 2003 and September 2003. The surgeon performed these cases after first assisting in 30 cases, and the first 4 cases were proctored by an experienced laparoscopic bariatric surgeon. Two cases done after previous gastric stapling and Nissen fundoplication were excluded from the study. Outcome variables included operative time, complications, conversion, and mortality. RESULTS:For the first 100 LRYGBP patients, the mean age was 42.6 years (range, 22-62 years) and mean body mass index (BMI) was 47.6 kg/m2 (range, 36-71.8). The complications included 1 case of intestinal leak, 1 case of small bowel obstruction, 6 cases of gastrojejunal stenosis, 8 cases of wound infection, 1 case of wound seroma, and 2 cases of pulmonary embolism, resulting in 1 mortality. One case was converted to an open technique. Over the second 50 cases, there was a significant reduction in mean operative time, to 73 minutes (range, 39-145 minutes) from 113 minutes (range, 54-238 minutes) (P < .0001). However, despite the reduction in complication frequency (no gastrointestinal leak or obstruction, 2 cases of gastrojejunal stenosis, 2 cases of wound infection, no pulmonary embolism/deep venous thrombosis, and no mortality), there was no significant correlation between the mortality, conversion, and complication rates and the surgeon's experience. CONCLUSION:A bariatric surgical practice incorporating LRYGBP can be safely done by an experienced laparoscopic surgeon. With appropriate advanced laparoscopic skills, preparatory steps, proctorship, and adequate volume of cases, the learning curve for performing LRYGBP can be reduced to 50 cases. Further experience is associated with a significant reduction in operative time with acceptable mortality, complication, and conversion rates.

译文

背景:文献报道腹腔镜Roux-en-Y胃旁路术(LRYGBP)的学习曲线约为75-100例。本研究的目的是评估由经验丰富的腹腔镜外科医生缩短进行LRYGBP学习曲线的安全性和可行性。
方法:本研究回顾性分析了2003年4月至2003年9月由经验丰富的腹腔镜外科医生进行的前100例连续LRYGBP病例。在首次协助30例患者之后,外科医生进行了这些病例,前4例病例由经验丰富的腹腔镜肥胖手术医师指导。该研究排除了先前进行胃吻合术和尼森胃底折叠术后完成的两个病例。结果变量包括手术时间,并发症,转化率和死亡率。
结果:前100名LRYGBP患者的平均年龄为42.6岁(范围22-62岁),平均体重指数(BMI)为47.6 kg / m2(范围36-71.8)。并发症包括肠漏1例,小肠梗阻1例,胃空肠狭窄6例,伤口感染8例,伤口血清肿1例和肺栓塞2例,导致1例死亡。一个案例被转换为开放技术。在后50例中,平均手术时间从113分钟(54-238分钟)减少到73分钟(39-145分钟)(P <.0001)。然而,尽管并发症发生率降低(无胃肠道渗出或阻塞,2例胃肠空肠狭窄,2例伤口感染,无肺栓塞/深静脉血栓形成,无死亡率),但死亡率,转化率之间无显着相关性。 ,并发症发生率和外科医生的经验。
结论:有经验的腹腔镜外科医生可以安全地进行结合了LRYGBP的减肥手术。借助适当的高级腹腔镜检查技巧,准备步骤,指导以及适当的病例数量,可以将进行LRYGBP的学习曲线减少到50例。进一步的经验可以显着减少手术时间,并具有可接受的死亡率,并发症和转化率。

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