Does establishing a bariatric surgery fellowship training program influence operative outcomes?

Abstract

Roux-en-Y gastric bypass (RYGB) has a long learning curve that may be reflected in operative outcomes. This study sought to assess whether training a fellow has an impact on the operative outcomes of the training program. Prospectively collected data on 150 consecutive patients were compared before (group 1) and after (group 2) establishment of a fellowship-training program. A greater number of patients underwent laparoscopic RYGB (LRYGB) in group 2 than in group 1 (63% vs 46%; p = 0.01). The group 2 patients were similar to the group 1 patients in terms of age, gender, length of stay, and complication rate. However, they had a higher body mass index (BMI) (median 50 kg/m2; range, 39-64 kg/m2 vs median, 46 kg/m2; range, 38-56 kg/m2; p = 0.01) and a higher incidence of prior abdominal procedures (21% vs 7%; p = 0.006). In addition, operative time was significantly shorter for the patients who underwent open RYGB (ORYGB) (median, 150 min; range, 65-280 min vs median, 110 min; range, 50-210 min; p < 0.001) and LRYGB (median, 202 min; range, 105-450 min vs median, 134 min; range, 50-191 min; p < 0.001) in group 2 than for the patients in group 1. The patients who underwent ORYGB in groups 1 and 2 had similar characteristics and outcomes. Increasing experience with both ORYGB and LRYGB correlated with a decrease in operative times for group 2 (p < 0.001), but not for group 1. Establishment of a fellowship program shortens the operative times for both open and laparoscopic RYGB and expands the scope of bariatric practice by compounding the experience of the operating team without increasing complications.