Kothari Shanu N, Boyd William C, Lambert Pamela J, Mathiason Michelle A
Department of Surgery, Gundersen Lutheran Health System, La Crosse, Wisconsin, USA.
Surg Innov. 2008 Dec;15(4):317-20. doi: 10.1177/1553350608327169.
The objective of this study is to assess the impact of establishing a fellowship training program on a center's laparoscopic gastric bypass (LGB) outcomes. The authors compare their prefellowship and postfellowship LGB outcomes by means of retrospective review of a prospectively maintained bariatric database. Theirs is an academic community hospital that instituted a minimally invasive bariatric program in 2001 and an advanced laparoscopic fellowship with emphasis in laparoscopic gastric bypass in 2003. Participants were patients undergoing LGB from the inception of the program. All prefellowship LGBs were performed and assisted by the same surgeon and assistant. Results show that prefellowship and postfellowship patient demographics were similar. The mean length of stay was 2.17 and 2.35 days, respectively. The percentage excess weight loss was 72% and 72%, respectively (p = 0.990). Major or minor complication rates were not significantly different between groups. The prefellowship operative time was 123 +/- 22 minutes, compared with 154 +/- 28 minutes postfellowship (P = .001). In conclusion, a training-related increase in operative time was the only difference in the 2 groups. An advanced laparoscopic fellowship training program with emphasis in LGB can be safely established without compromising the center's LGB outcomes.
本研究的目的是评估建立一个 fellowship 培训项目对中心腹腔镜胃旁路术（LGB）治疗效果的影响。作者通过对前瞻性维护的肥胖症数据库进行回顾性分析，比较了 fellowship 培训前和培训后的 LGB 治疗效果。这是一家学术社区医院，于 2001 年设立了微创肥胖症项目，并于 2003 年设立了以腹腔镜胃旁路术为重点的高级腹腔镜 fellowship 培训项目。研究对象为自该项目启动以来接受 LGB 手术的患者。所有培训前的 LGB 手术均由同一位外科医生和助手完成并协助。结果显示，培训前和培训后的患者人口统计学特征相似。平均住院时间分别为 2.17 天和 2.35 天。超重减轻百分比分别为 72%和 72%（p = 0.990）。两组之间的主要或次要并发症发生率无显著差异。培训前的手术时间为 123±22 分钟，而培训后为 154±28 分钟（P = 0.001）。总之，手术时间与培训相关的增加是两组之间唯一的差异。可以安全地建立一个以 LGB 为重点的高级腹腔镜 fellowship 培训项目，而不会影响中心的 LGB 治疗效果。
