Learning curve for two-site incision laparoscopic Roux-en-y gastric bypass

SummaryBackgroundSingle-incision laparoscopic surgery (SILS) has emerged recently, and this procedure minimizes surgical trauma. Laparoscopic Roux-en-Y gastric bypass is one of the most effective bariatric surgeries. From five to seven small skin incisions are usually required to perform this procedure. In regard to the single-incision laparoscopic surgery procedure, we developed a modified single-laparoscopic technique (2-site incision technique) to perform a Roux-en-Y gastric bypass. Our method and the associated learning curve will be presented here.MethodsThree hundred consecutive patients with a mean age of 31.7 years (range, 19–52 years) underwent a two-site incision laparoscopic Roux-en-Y gastric bypass (TILRYGB) between February 2009 and December 2010. The mean body mass index of the patients was 40.5 kg/m2 (range, 30.1–59.9 kg/m2) preoperatively. The same perioperative protocol and surgical technique were used in all patients. These 300 patients were equally divided into three groups in sequence. The pre- and postoperative data were collected and compared.ResultsThe TILRYGB procedure was performed successfully in all patients. The mean operative time of the groups in sequence was 170.9 minutes, 157.3 minutes, and 149.0 minutes. No perioperative major complications occurred. Minor complications occurred in these three groups in five, three, and zero cases. These minor complications included gastrointestinal bleeding and ileus, all of which resolved with conservative treatment. The mean hospital stay in sequence was 4.1 days, 3.8 days, and 3.5 days.ConclusionTILRYGB is a safe, feasible, and reproducible bariatric procedure; once the learning curve is overcome, it can provide better postoperative results than other surgical procedures.