Incorporating Laparoscopic Fellowship Does Not Increase Morbidity or Mortality in a University-Based Bariatric Practice - 19/08/11

Doi : 10.1016/j.jamcollsurg.2007.01.034

Ronald H. Clements, MD, FACS ^⁎ , Ruth R. Leeth, MPH ^†, Selwyn M. Vickers, MD, FACS ^†, Kirby I. Bland, MD, FACS
Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
^† Department of Surgery, University of Minnesota, Minneapolis, MN.

Correspondence address: Ronald H Clements, MD, Department of Surgery, University of Alabama at Birmingham, KB 404, 1530 3rd Ave South, Birmingham, AL 35294-0016.

Résumé

Background

Minimally invasive surgery (MIS) fellowship is one of the most sought-after positions after residency. The increased use of bariatric operations has provided an abundance of advanced cases. The aim of this article is to determine if the addition of an MIS fellowship program has any impact on morbidity and mortality in a university-based bariatric program.

Study Design

Data from all laparoscopic gastric bypasses (LGBs) performed by one surgeon (RHC) from September 2001 until June 2006 were prospectively entered into a database, which was reviewed for morbidity and mortality before (group 1) and after (group 2) development of the MIS program. Mean operative time, length of hospital stay, anastomotic leaks and strictures, gastrointestinal bleeds, internal hernia, and mortality were compared between the two groups of patients using t-tests with significance of p = 0.05.

Results

A total of 761 (group 1, n = 397; group 2, n = 364) LGBs were performed. For the total population, operating room time was 104 ± 24 minutes and length of hospital stay was 2 ± 0.3 days. Incidences of morbidities are as follows: leaks, 0.53%; marginal ulcer, 5.0%; anastomotic stricture, 6.7%; incarcerated internal hernia, 2.2%; gastric outlet obstruction, 0.53%; gastrointestinal bleed, 0.09%; and mortality, 0.13%. Comparing groups 1 and 2, mean operating room time was longer in group 2, but there was no marked difference between any of the other variables.

Conclusions

Addition of an MIS fellowship does not change the morbidity and mortality of LGB when developed in the context of a university-based bariatric practice that uses a systematic approach to preoperative evaluation, operative technique, and postoperative management.

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Abbreviations and Acronyms : BMI, LGB, MIS