Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 4.156, Houston, TX, 77030, USA.
Southwestern Center for Minimally Invasive Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Surg Endosc. 2023 Jun;37(6):4824-4828. doi: 10.1007/s00464-022-09622-y. Epub 2022 Sep 22.
The field of bariatric surgery has seen peaks and troughs in the types of metabolic procedures performed. Our primary aim was to evaluate bariatric case volumes among fellows enrolled in bariatric Fellowship Council (FC)-accredited programs. Our secondary aim was to assess trends in revisional case volumes.
We reviewed de-identified FC case logs for all bariatric surgery-accredited programs from 2010 through 2019. The number of primary sleeve gastrectomy, gastric band, gastric bypass, biliopancreatic diversion, and major revisional bariatric surgical procedures (defined as a revision with creation of a new anastomosis) were graphed for each academic year. Fellows were stratified into quartiles based on the number of revisional operations per year and graphed over ten years. Volumes of primary gastric bypass, major revisions, and total anastomotic cases were compared over time using ANOVA with p < 0.05 considered significant.
Case volumes for 822 fellows were evaluated. Sleeve gastrectomy had a significant surge in 2010 and plateaued in 2016. The fellows' number of primary gastric bypasses had a non-significant decrease from 84 to 75 cases/fellow from 2010 to 2019. This decrease was offset by a significant increase in major revisional surgery from 8 to 19 cases/fellow. As a result, the number of anastomotic cases did not change significantly over the study time period. Interestingly, as revisional volume has grown, the gap between quartiles of fellowship programs has widened with the 95th percentile growing at a much faster rate than lower quartiles.
The volume of bariatric procedures performed in the last decade among FC fellows follows similar trends to national data. Major revisional cases have doubled with the most robust growth isolated to a small number of programs. As revisional surgery continues to increase, applicants interested in a comprehensive bariatric practice should seek out training programs that offer strong revisional experience.
减重外科领域所开展的代谢手术类型经历了高峰和低谷。我们的主要目的是评估参加减重外科学院认证（FC）项目的住院医师的减重病例数量。我们的次要目的是评估修正手术数量的趋势。
我们回顾了 2010 年至 2019 年所有获得减重外科认证的 FC 病例记录。每年记录主要袖状胃切除术、胃带术、胃旁路术、胆胰分流术和主要修正性减重手术（定义为创建新吻合口的修正）的数量。根据每年修正手术的数量，将住院医师分为四组，并在十年内进行图表绘制。使用方差分析比较每年胃旁路术、重大修正术和总吻合术病例数量的变化，p<0.05 认为差异有统计学意义。
评估了 822 名住院医师的病例数量。袖状胃切除术在 2010 年显著增加，并在 2016 年达到平台期。住院医师的主要胃旁路术数量从 2010 年的 84 例/人减少到 2019 年的 75 例/人，但无统计学意义。这一减少被主要修正手术数量的显著增加所抵消，从 8 例/人增加到 19 例/人。因此，在研究期间，吻合术数量没有显著变化。有趣的是，随着修正手术数量的增加，住院医师项目的四分位间距也在扩大，第 95 百分位数的增长速度明显快于较低的四分位数。
在过去十年中，FC 住院医师进行的减重手术数量与全国数据的趋势相似。主要修正手术数量增加了一倍，增长最快的主要集中在少数几个项目中。随着修正手术的持续增加，对综合减重手术感兴趣的申请人应寻求提供强大修正手术经验的培训项目。
