Impact of fellowship training on the learning curve for laparoscopic gastric bypass

Background: We have previously shown that the learning curve for laparoscopic Roux-en-Y gastric bypass (LRYGBP) is approximately 75 cases. Patients have worse outcomes during the learning curve. Our aim was to evaluate the impact of fellowship training on outcomes during a surgeon's early experience with LRYGBP. Methods: The study population consisted of the first 75 consecutive LRYGBP operations attempted by two laparoscopic surgeons, one with laparoscopic gastric bypass fellowship training (Group A) and one without laparoscopic bypass fellowship training (Group B). Outcome parameters included mortality, major perioperative complications, operative time, and conversion to an open operation. Results: Age, BMI, and gender distribution were similar in both groups. Operative time was significantly longer in Group B (189 min. vs 122 min., P<0.05). Conversion to an open procedure occurred uncommonly in both groups (3%). Major complications occurred more frequently in Group B (13% vs 8%, P=NS). In addition, the complications in Group B were more severe, resulting in 2 deaths. No deaths occurred in Group A. Conclusion: Laparoscopic gastric bypass fellowship training improves perioperative outcomes during a surgeon's early experience with LRYGBP.