Training of a minimally invasive bariatric surgeon: Are laparoscopic fellowships the answer?

Background: Fellowships in advanced laparoscopy with emphasis in laparoscopic gastric bypass (LGBP) are available for obtaining experience in performing LGBP. The following is the first report in the literature prospectively documenting a single surgeon's experience with LGBP outcomes following completion of an advanced laparoscopic surgical fellowship. Methods: Outcomes measured prospectively included length of stay, length of operation, complications, reduction in obesity-related co-morbidities, and percentage excess weight loss. Outcomes were analyzed by quartile to see if there was a difference over time. Complications were also compared to outcomes in the literature. Results: 175 patients (147 female, 28 male) underwent LGBP. The mean BMI was 49.2. Mean operative time was 123 minutes, and mean length of stay was 2.2 days. The percentage excess weight loss at 1 year was 73% (n = 79). One patient developed an internal hernia (0.6%) and 1 patient developed an anastomotic leak (0.6%). Postoperative transfusion rate was 4.6%. There were no deep venous thromboses or pulmonary emboli detected. There were no conversions to open, and there was no mortality. Upon quartile analysis, there was no difference in complication rates. Complication rates were comparable to published outcomes in the literature. Conclusion: Fellowships in advanced laparoscopy with emphasis on LGBP provide the optimal training environment for acquisition of skills necessary to safely and effectively perform LGBP. With fellowship training, complication rates were comparable to published outcomes in the literature without a period of higher complications (the learning curve).