Kuckelman John, Bingham Jason, Barron Morgan, Lallemand Michael, Martin Matthew, Sohn Vance
Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, USA.
Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, USA.
Am J Surg. 2017 May;213(5):963-966. doi: 10.1016/j.amjsurg.2017.03.031. Epub 2017 Mar 27.
Bariatric surgery makes up an increasing percentage of general surgery training. The safety of resident involvement in these complex cases has been questioned. We evaluated patient outcomes in resident performed laparoscopic bariatric procedures.
Retrospective review of patients undergoing a laparoscopic bariatric procedure over seven years at a tertiary care single center. Procedures were primarily performed by a general surgery resident and proctored by an attending surgeon. Primary outcomes included operative volume, operative time and leak rate with perioperative outcomes evaluated as secondary outcomes.
A total of 1649 bariatric procedures were evaluated. Operations included laparoscopic bypass (690) and laparoscopic sleeve gastrectomy (959). Average operating time was 136 min. Eighteen leaks (0.67%) were identified. Graduating residents performed an average of 89 laparoscopic bariatric cases during their training. There were no significant differences between resident levels with concern to operative time or leak rate (p 0.97 and p = 0.54).
General surgery residents can safely perform laparoscopic bariatric surgery. When proctored by a staff surgeon, a resident's level of training does not significantly impact leak rate.
减重手术在普通外科培训中所占比例日益增加。住院医师参与这些复杂病例的安全性受到质疑。我们评估了住院医师实施的腹腔镜减重手术的患者预后。
对一家三级医疗单中心7年间接受腹腔镜减重手术的患者进行回顾性研究。手术主要由普通外科住院医师实施，并由主治医生指导。主要结局包括手术量、手术时间和渗漏率，围手术期结局作为次要结局进行评估。
共评估了1649例减重手术。手术包括腹腔镜旁路手术（690例）和腹腔镜袖状胃切除术（959例）。平均手术时间为136分钟。发现18例渗漏（0.67%）。即将毕业的住院医师在培训期间平均实施89例腹腔镜减重手术。住院医师级别在手术时间或渗漏率方面无显著差异（p = 0.97和p = 0.54）。
普通外科住院医师可以安全地实施腹腔镜减重手术。在有上级医生指导时，住院医师的培训水平对渗漏率无显著影响。
