Learning curve of laparoscopic Roux-en-Y gastric bypass in an Asian low-volume bariatric unit

BACKGROUND: Obesity has become a healthcare burden in Taiwan and the rest of Asia. Laparoscopic Roux-en-Y gastric bypass (LRYGB) provides good weight loss outcome, and improves comorbidity as well as quality of life. We present our experience of the learning curve for LRYGB in a low-volume bariatric unit.

METHODS: From March 2009 to August 2011, 60 consecutive patients who underwent LRYGB were included. They were separated into two groups, with the first 30 cases in Group 1 and the remaining 30 cases in Group 2. Indicators for evaluating the learning curve for LRYGB included surgical time, rate of conversion to open surgery, surgical and total complication rates, length of hospital stay, mortality, and postoperative weight loss.

RESULTS: There were no significant differences in demographic measurements between the two groups. In Group 1, the median surgical time was 120 minutes and in Group 2 it was 80 minutes (p<0.01). Two cases were converted to laparotomy in Group 1, but none in Group 2. There was no surgical mortality and the total complication rate of all patients was 16.7%. The complication rate significantly decreased from Group 1 (26.7%) to Group 2 (6.7%). Three patients needed further surgical procedures in Group 1, with no patients needing them in Group 2. There was no significant difference in hospital stay and percentage excess weight loss between the two groups.

CONCLUSION: The learning curve for LRYGB has no mortality and an acceptable complication rate. The operating time and morbidity rate are the indicators for overcoming the learning curve.