Division of Trauma and Emergency Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan, ROC.
BMC Surg. 2021 Feb 15;21(1):86. doi: 10.1186/s12893-021-01058-w.
This study aimed to reevaluate the learning curve of laparoscopic Roux-en Y gastric bypass (LRYGB) in the modern era while considering a single surgeon's experience.
From the beginning of our LRYGB practice, all patients who met the regional criteria and underwent primary LRYGB were retrospectively enrolled. Patients with a body mass index (BMI) > 50 kg/m were excluded. Those who underwent surgery in 2016-17, 2018 and 2019 by a single surgeon with 10 + years of laparoscopic experience were assigned to groups A, B and C, respectively. The patient demographics and 30-day outcome data, including the operation time, length of stay (LOS), emergency room visits, readmission, and reoperation, were compared among the groups.
One hundred and eight patients met the inclusion criteria; 36, 38, and 34 patients were assigned to groups A, B and C, respectively. There were no differences in age, sex distribution or common comorbidities among the groups; however, B had a lower BMI (35.1 kg/m vs. 37.0 kg/m) and a higher rate of hypertension (44.7% vs. 22.2%) than group A. The operation time was markedly reduced (96.1 min and 114.9 min, p < 0.001), and the LOS was shortened (2.2 days and 2.9 days, p < 0.001) in group B compared to group A and remained stationary in group C, with no further reduction in 30-day complications.
The learning process of LRYGB can be shortened to approximately 30 cases if conducted selectively by experienced laparoscopic surgeons. Further follow-up is required to verify the long-term safety and applicability in other patient subgroups.
本研究旨在重新评估腹腔镜 Roux-en Y 胃旁路术（LRYGB）在现代的学习曲线，同时考虑一位外科医生的经验。
从我们开始进行 LRYGB 手术开始，所有符合区域标准并接受初次 LRYGB 的患者都被回顾性纳入研究。体重指数（BMI）>50kg/m 的患者被排除在外。由一位有 10 多年腹腔镜经验的外科医生进行手术的患者，如果手术时间在 2016-17 年、2018 年和 2019 年，则分别归入组 A、B 和 C。比较组间患者人口统计学和 30 天结局数据，包括手术时间、住院时间（LOS）、急诊就诊、再入院和再次手术。
108 例患者符合纳入标准；36、38 和 34 例患者分别被归入组 A、B 和 C。三组患者的年龄、性别分布或常见合并症无差异；但 B 组 BMI 较低（35.1kg/m 比 37.0kg/m），高血压发生率较高（44.7%比 22.2%）。与组 A 相比，B 组手术时间明显缩短（96.1 分钟和 114.9 分钟，p<0.001），住院时间缩短（2.2 天和 2.9 天，p<0.001），而 C 组则保持不变，30 天并发症没有进一步减少。
如果由经验丰富的腹腔镜外科医生选择性地进行，LRYGB 的学习过程可以缩短到大约 30 例。需要进一步随访以验证其在其他患者亚组中的长期安全性和适用性。
