Søvik Torgeir T, Aasheim Erlend T, Kristinsson Jon, Schou Carl Fredrik, Diep Lien My, Nesbakken Arild, Mala Tom
Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Medicine, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway.
Obes Surg. 2009 Feb;19(2):158-165. doi: 10.1007/s11695-008-9584-x. Epub 2008 Jun 20.
Bariatric surgery was established at several Norwegian hospitals in 2004. This study evaluates the perioperative outcome and the learning curves for two surgeons while introducing laparoscopic Roux-en-Y gastric bypass (LRYGB).
Morbidly obese patients undergoing primary LRYGB were included. Lengths of surgery and postoperative hospital stay, and 30-day rates of morbidity, reoperations, and readmissions were set as indicators of the learning curve. Learning effects were evaluated by graphical analyses and comparing the first and last 40 procedures for both surgeons.
The 292 included patients had a mean age of 40.0 +/- 9.5 years and a mean body mass index (BMI) of 46.7 +/- 5.3 kg/m(2). The mean length of surgery was 101 +/- 55 min. Complications occurred in 43 patients (14.7%), with no conversions to open surgery in the primary procedure and no mortality. Reoperations were performed in 14 patients (4.8%), of which five patients required open surgery. The median length of stay was 3 days (range 1-77), and 19 patients (6.5%) were readmitted. High patient age, but not high BMI, was associated with an increased risk of complication. For both surgeons, lengths of surgery and hospital stay were significantly reduced (p < 0.001), leveling out after 100 procedures. Reductions in the rates of morbidity, reoperations and readmissions were not found.
LRYGB was introduced with an acceptable morbidity rate and no mortality. Only the length of surgery and postoperative hospital stay were suitable indicators of a learning curve, which comprised about 100 cases.
2004年挪威几家医院开展了减肥手术。本研究评估了两位外科医生在引入腹腔镜Roux-en-Y胃旁路术（LRYGB）时的围手术期结果和学习曲线。
纳入接受初次LRYGB的病态肥胖患者。将手术时长、术后住院时间以及30天内的发病率、再次手术率和再入院率作为学习曲线的指标。通过图形分析以及比较两位外科医生的前40例和后40例手术评估学习效果。
纳入的292例患者平均年龄为40.0±9.5岁，平均体重指数（BMI）为46.7±5.3kg/m²。平均手术时长为101±55分钟。43例患者（14.7%）出现并发症，初次手术无转为开放手术的情况，无死亡病例。14例患者（4.8%）接受了再次手术，其中5例患者需要进行开放手术。中位住院时间为3天（范围1 - 77天），19例患者（6.5%）再次入院。患者年龄高而非BMI高与并发症风险增加相关。对于两位外科医生而言，手术时长和住院时间均显著缩短（p < 0.001），在100例手术后趋于平稳。未发现发病率、再次手术率和再入院率有所降低。
引入LRYGB时发病率可接受，无死亡病例。只有手术时长和术后住院时间是学习曲线的合适指标，学习曲线约包含100例病例。
