Schauer P, Ikramuddin S, Hamad G, Gourash W
Department of Surgery, The Minimally Invasive Surgery Center, University of Pittsburgh, Presbyterian University Hospital, C-800, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA.
Surg Endosc. 2003 Feb;17(2):212-5. doi: 10.1007/s00464-002-8857-z. Epub 2002 Dec 4.
The purpose of this study was to determine the effect of operative experience on perioperative outcomes for laparoscopic Roux-en-Y gastric bypass (LGB).
Between July 1997 and September 2001, 750 patients underwent LGB for the treatment of morbid obesity at our center. We evaluated the perioperative outcomes of the first 150 consecutive patients to determine if a learning curve effect could be demonstrated. The patients were divided into three groups (1, 2, and 3) of 50 consecutive patients, and outcomes for each group were compared.
The patients in group 3 had a larger body mass index (BMI), were more likely to have had prior abdominal surgery, and were more likely to have secondary operations at the time of LGB. Operating time decreased from a mean of 311 min in group 11 to 237 min in group 3, and technical complications were reduced by 50% after an experience of 100 cases.
Operative time and technically related complications decreased with operative experience even though heavier patients and higher-risk patients were more predominant in the latter part of our experience. LGB is a technically challenging operation with a long learning curve. To minimize morbidity related to the learning curve, strategies for developing training programs must address these challenges.
本研究的目的是确定手术经验对腹腔镜Roux-en-Y胃旁路术（LGB）围手术期结局的影响。
1997年7月至2001年9月期间，750例患者在我们中心接受了LGB治疗病态肥胖症。我们评估了连续150例患者的围手术期结局，以确定是否能证明存在学习曲线效应。将患者分为三组（第1组、第2组和第3组），每组50例连续患者，并比较每组的结局。
第3组患者的体重指数（BMI）更高，更有可能曾接受过腹部手术，并且在进行LGB时更有可能接受二次手术。手术时间从第1组的平均311分钟降至第3组的237分钟，在积累100例经验后，技术并发症减少了50%。
尽管在我们的经验后期，病情较重的患者和高风险患者更为常见，但手术时间和技术相关并发症随着手术经验的增加而减少。LGB是一项技术上具有挑战性的手术，学习曲线较长。为了将与学习曲线相关的发病率降至最低，制定培训计划的策略必须应对这些挑战。
