Global Benchmark Values for Laparoscopic Roux-en-Y-Gastric Bypass: a Potential New Indicator of the Surgical Learning Cu
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ORIGINAL CONTRIBUTIONS
Global Benchmark Values for Laparoscopic Roux-en-Y-Gastric Bypass: a Potential New Indicator of the Surgical Learning Curve Guillaume Giudicelli 1,2 & Michele Diana 1,3,4 & Mickael Chevallay 1,2 & Benjamin Blaser 1,5 & Chloé Darbellay 1 & Laetitia Guarino 1 & Minoa K. Jung 2 & Marc Worreth 1 & Daniel Gero 6 & Alend Saadi 1 Received: 17 June 2020 / Revised: 2 October 2020 / Accepted: 6 October 2020 # The Author(s) 2020
Abstract Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a technically demanding procedure. The learning curve of LRYGB is challenging and potentially associated with increased morbidity. This study evaluates whether a general laparoscopic surgeon can be safely trained in performing LRYGB in a peripheral setting, by comparing perioperative outcomes to global benchmarks and to those of a senior surgeon. Methods All consecutive patients undergoing primary LRYGB between January 2014 and December 2017 were operated on by a senior (A) or a trainee (B) bariatric surgeon and were prospectively included. The main outcome of interest was all-cause morbidity at 90 days. Perioperative outcomes were compared with global benchmarks pooled from 19 international high-volume centers and between surgeons A and B for their first and last 30 procedures. Results The 213 included patients had a mean all-cause morbidity rate at 90 days of 8% (17/213). 95.3% (203/213) of the patients were uneventfully discharged after surgery. Perioperative outcomes of surgeon B were all within the global benchmark cutoffs. Mean operative time for the first 30 procedures was significantly shorter for surgeon A compared with surgeon B, with 108.6 min (± 21.7) and 135.1 min (± 28.1) respectively and decreased significantly for the last 30 procedures to 95 min (± 33.7) and 88.8 min (± 26.9) for surgeons A and B respectively. Conclusion Training of a new bariatric surgeon did not increase morbidity and operative time improved for both surgeons. Perioperative outcomes within global benchmarks suggest that it may be safe to teach bariatric surgery in peripheral setting. Keywords Global benchmark . Laparoscopic Roux-en-Y-gastric bypass . Learning curve
Daniel Gero and Alend Saadi are senior authors of the study. * Guillaume Giudicelli [email protected] 1
Department of Surgery, Neuchâtel Hospital, Rue de la Maladière 45, 2000 Neuchâtel, Switzerland
2
Division of Visceral Surgery, Department of Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
3
IRCAD, Research Institute against Digestive Cancer, Strasbourg, France
4
Department of Surgery, Strasbourg University Hospital, 1 Place de l’Hôpital, 67000 Strasbourg, France
5
Department of Visceral Surgery, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
6
Department of Surgery and Transplantation, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
Introduction Bariatric surgery improves obesity-related comorbidities and quality of life. It is also the onl
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