Three hundred laparoscopic Roux-en-Y gastric bypasses: managing the learning curve in higher risk patients.

BACKGROUND: Bariatric surgery is expanding and the increasing workload needs to be undertaken safely in new surgical centres with no previous bariatric experience. The laparoscopic Roux-en-Y gastric bypass (LRYGB) has a steep learning curve with documented high risk. We present the results for the first 300 cases of LRYGB in a new centre. METHODS: Three hundred consecutive patients underwent LRYGB performed by a single surgeon. Four external surgeons mentored eight cases in the first 50. Demographic characteristics, body mass index (BMI) and operative time were collected prospectively and the Obesity Surgery Mortality Risk Score was used for risk stratification. RESULTS: The mean BMI of the patients increased during the series from 49.0 for the first group to 50.2 for the second group and to 51.0 for the third group (p < 0.05). The number of high-risk patients measured with the OS-MRS was 19/300 (6.3%) in the whole series. The mean operative time decreased from 163 min for the first 100 patients to 119 min for the second 100 and 94 for the third (p < 0.0001). In the first group, there were nine reoperations and two conversions to open surgery, compared to two reoperations and one conversion in the second group (p < 0.05). In the whole series, there were 12 early complications requiring re-operation, four conversions to open surgery and one mortality (patient 110, heart failure within 24 h). CONCLUSIONS: A mentoring process ensures that LRYGB can be done safely in a newly established bariatric centre. The operative time reduces markedly after the learning curve.

Paid work increases and state benefit claims decrease after bariatric surgery.

BACKGROUND: Bariatric surgery is a clinically effective treatment for obesity and has been shown to be cost-effective. The impact of bariatric surgery on the subsequent ability to work and the uptake of state-funded benefits is not well documented. METHODS: A consecutive series of 79 patients who had undergone laparoscopic Roux-en-Y gastric bypass (LRYGBP) or laparoscopic adjustable gastric banding (LAGB) were surveyed to assess changes in their ability to work and the number and type of state benefits claimed after surgery. RESULTS: 59 patients (75%) responded, median age 45, median follow-up 14 months. There was a 32% increase in the number of respondents in paid work after surgery (P<0.05). The mean weekly hours worked increased from 30.1 to 35.8 hours (P<0.01). Respondents also reported a decrease in obesity-related physical and emotional constraints on their ability to do work (P<0.01). Fewer patients claimed state benefits postoperatively (P<0.01). CONCLUSION: More patients perform paid work after LRYGBP and LAGB than beforehand, and the number of weekly hours they work increases. After surgery, patients claim fewer state benefits.