Leveling the learning curve for laparoscopic bariatric surgery

Background: The learning Curve for laparoscopic bariatric surgery is associated with increased morbidity and mortality. Methods: The study included the first 100 patients undergoing laparoscopic Roux-en-Y gastric bypass (LGB) by a designated Surgical team. Surgeon A operated as primary surgeon with surgeon B assisting (Stage 1). Surgeon B learned LGB in stages: exposure and jejunojejunostomy (stage 2), gastric pouch (stage 3), gastrojejunostomy (stage 4), and sequence all steps (stage 5). Results: Surgeon A achieved confidence with LGB after 20 cases and surgeon B after 25 cases (stage 2), 18 cases (stage 3), 21 cases (stage 4),. and 16 cases (stage 5). Complications (8 %) included small bowel obstruction (three); pulmonary embolus (two), and leak, stomal stenosis, and gastrogastric fistula (one each). There was a decreasing trend for operative duration, length of stay, and complications across the five stages (p < 0.05). Conclusions: By transferring skills in stages, a laparoscopic bariatric program can be established with minimal morbidity and mortality.