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Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass

Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass,10.10

Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass   (Citations: 6)
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Background  The concept that advanced surgical training can reduce or eliminate the learning curve for complex procedures makes logical sense but is difficult to verify and has not been tested for laparoscopic Roux-en-Y gastric bypass (LRYGB). We sought to determine if minimally invasive/bariatric surgery fellowship graduates (FGs) would demonstrate complication-related outcomes (CRO) equivalent to the outcomes achieved during their training experience under the supervision of experienced bariatric surgeons. Methods  We compared CRO for the first 100 consecutive LRYGBs performed in practice by five consecutive minimally invasive/bariatric fellows at new institutions (total 500 cases) to CRO for the 611 consecutive LRYGBs performed during their fellowship training experience under the supervision of three experienced bariatric surgeons at the host training institution. Results  The two patient groups did not differ demographically. The 18 types of major and minor complications identified after LRYGB did not differ among the five fellowship graduates. The mentors’ CRO were compatible with published benchmark data. As compared with the training institution data, the overall incidence of complications for the combined experience of fellowship graduates did not differ statistically from that of the mentors. The fellowship graduates’ early experience included zero nongastrojejunostomy leaks (0% versus 1.5%) and a low rate of anastomotic stricture (0.8% versus 3.0%), incisional hernia (1% versus 4.4%), bowel obstruction (0% versus 3%), wound infection (0.3% versus 3.1%), and gastrointestinal hemorrhage (0.2% versus 1.6%). The rate of gastrojejunostomy leak (1.8% versus 2.6%) and, most importantly, mortality (0.8% versus 0.7%) did not differ between the two groups. Conclusions  Fellowship graduates achieved high-quality surgical outcomes from the very beginning of their postfellowship practices, which are comparable to those of their experienced mentors. These data validate the concept that advanced surgical training can eliminate the learning curve often associated with complex minimally invasive procedures, specifically LRYGB.
Journal: Surgical Endoscopy and Other Interventional Techniques - SURG ENDOSC , vol. 24, no. 1, pp. 138-144, 2010
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    • ...To be proficient at ASMBS, surgeons need to document 100 bariatric procedures, 50 of those as the primary surgeon with satisfactory outcomes from residency and/or fellowship under the supervision of an experienced surgeon [19]...
    • ...The same conclusion is derived from the work to assess the impact of bariatric surgery fellowship that takes place in the USA [6, 19, 20, 35]...
    • ...Although the choice of 1-year fellowship seems the best option to ensure adequate training for a bariatric surgeon, it is not operational because the absence of official government programs in most countries makes it difficult to universalize [6, 19, 20, 35]...

    Raquel Sánchez-Santoset al. Training Programs Influence in the Learning Curve of Laparoscopic Gast...

    • ...In a recent paper [5], Ali et al. compared complication-related outcomes for the first 100 consecutive LRYGB performed by five fellows at new institutions to the outcomes for LRYGB performed during their fellowship training at the host training institution...
    • ...Ali et al. concluded that advanced surgical training can eliminate the learning curve associated with LRYGB [5]...

    Sanjay Agrawal. Impact of Bariatric Fellowship Training on Perioperative Outcomes for ...

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