Department of General Surgery, Henry Ford Hospital, Detroit, MI, USA.
Surgery. 2012 Jul;152(1):21-5. doi: 10.1016/j.surg.2012.02.014. Epub 2012 Apr 11.
The majority of bariatric surgeons use dedicated surgical assistants when performing laparoscopic Roux-en-Y gastric bypass (LGBP) because of the technical difficulty and steep learning curve involved in the operation. At our institution, either a senior surgical resident (SSR) or a physician assistant (PA) participates in LGBP cases. The PA's role is confined to assisting, whereas the SSR progressively acts as the operating surgeon. We were interested in evaluating patient outcomes to determine whether any differences existed between the LGBP operations in which either the PA or the SSR participated.
All patients undergoing LGBP between January 2007 and December 2009 in our prospectively collected bariatric database were reviewed. Demographics, baseline measures, intraoperative parameters, and outcomes were compared.
A total of 711 patients were identified. The group involving PAs included 343 patients, and the group involving SSRs included 368 patients. Preoperative comorbidities, including diabetes, hypertension, coronary artery disease, asthma, sleep apnea, hyperlipidemia, musculoskeletal disability, and depression, were similar in both groups. Personal histories of venous thromboembolism were higher in the PA group (5.1% vs 2.5%; P = .075). The mean body-mass indexes (BMI) (53 ± 9 vs 51 ± 8 kg/m(2); P = .006) and weights (323 ± 67 vs 306 ± 59 lbs; P < .001) in the PA group were significantly higher than in the SSR group. The proportion of males was higher in the PA group (24% vs 16%; P = .008). The operative time was significantly shorter in the PA group (121 ± 36 vs 164 ± 30 minutes; P < .001). There was no significant difference between the groups in intraoperative complications, length of hospital stay, 30-day complications, or reoperations within 1 year. There were no mortalities in either group. The 1-year percent excess weight loss (64% vs 66%) was similar in the PA and SSR groups, respectively.
SSR participation in LGBP prolongs operative time but does not increase complications, mortality rates, or length of stay. Therefore, SSR participation in LGBP is safe and produces outcomes comparable to those performed with PAs.
由于腹腔镜 Roux-en-Y 胃旁路术（LGBP）操作难度大，学习曲线陡峭，大多数肥胖症外科医生在进行手术时都会使用专门的外科助手。在我们的机构中，高级住院医师（SSR）或医师助理（PA）都会参与 LGBP 手术。PA 的角色仅限于协助，而 SSR 则逐渐扮演手术医生的角色。我们有兴趣评估患者的结局，以确定 PA 或 SSR 参与的 LGBP 手术之间是否存在任何差异。
我们回顾了在我们前瞻性收集的肥胖症数据库中，2007 年 1 月至 2009 年 12 月期间接受 LGBP 的所有患者的资料。比较了人口统计学、基线指标、术中参数和结局。
共确定了 711 名患者。PA 组 343 例，SSR 组 368 例。两组患者的术前合并症，包括糖尿病、高血压、冠心病、哮喘、睡眠呼吸暂停、高脂血症、肌肉骨骼残疾和抑郁症，相似。PA 组的静脉血栓栓塞个人史更高（5.1%比 2.5%；P =.075）。PA 组的平均体重指数（BMI）（53 ± 9 比 51 ± 8 kg/m2；P =.006）和体重（323 ± 67 比 306 ± 59 磅；P <.001）明显高于 SSR 组。PA 组男性比例较高（24%比 16%；P =.008）。PA 组的手术时间明显缩短（121 ± 36 比 164 ± 30 分钟；P <.001）。两组患者在术中并发症、住院时间、30 天并发症或 1 年内再次手术方面均无显著差异。两组均无死亡病例。PA 组和 SSR 组 1 年体重超标减轻率（64%比 66%）相似。
SSR 参与 LGBP 手术会延长手术时间，但不会增加并发症、死亡率或住院时间。因此，SSR 参与 LGBP 是安全的，其结果与使用 PA 相似。
