Re-Appraisal Learning Curve of Laparoscopic Roux-En Y Gastric Bypass: Results of One Hundred and Eight Cases From A Low Volume Unit

Abstract Background The study aim was to reevaluate the learning curve of laparoscopic Roux-en Y gastric bypass (LRYGB) in the modern era considering a single surgeon’s experience.Methods Except those with body mass index (BMI) >50 kg/m2 needs further discussion; all other patients who met the regional criteria and underwent primary LRYGB were retrospectively enrolled. Those who underwent surgery in 2016-17, 2018 and 2019 by a single surgeon with 10+ years of laparoscopic experience were assigned to groups A, B and C, respectively. Patient demographics and 30-day outcome data, including operation time, length of stay (LOS), emergency room visits, readmission, and reoperation, were compared between groups.Results One hundred and eight patients met the inclusion criteria; 36, 38, and 34 patients were assigned to groups A, B and C, respectively. There were no differences in age, sex distribution or common comorbidities between groups, except group B had a lower BMI (35.1 kg/m2 vs. 37.0 kg/m2) and a higher rate of hypertension (44.7% vs. 22.2%) than group A. The operation time was markedly reduced (96.1 min and 114.9 min, respectively), and the LOS was shortened (2.2 days and 2.9 days, respectively) in group B compared to group A and remained stationary in group C, with no further reduction in 30-day complications.Conclusion The learning process for LRYGB can be shortened to approximately 30 cases if conducted selectively and by experienced laparoscopic surgeons. Further follow-up is required to verify the long-term safety and its applicability to other patient subgroups.