Obesity Surgery

, Volume 29, Issue 1, pp 143–148 | Cite as

Laparoscopic Sleeve Gastrectomy Learning Curve: Clinical and Economical Impact

  • Sergio CarandinaEmail author
  • Laura Montana
  • Marc Danan
  • Viola Zulian
  • Marius Nedelcu
  • Christophe Barrat
Original Contributions



The results in the literature regarding the learning curve (LC) of laparoscopic sleeve gastrectomy (LSG) are scarce and non-definitive. The purpose of the study was to evaluate the correlation between the LSG learning curve and intraoperative parameter variation, postoperative morbidity, weight loss results, and economic impact.


The first 99 obese patients undergoing LSG surgery by the same surgeon from March 2013 to April 2016 were included in the present study. Patients were equally distributed among three groups (A, B, C) based on case sequence.


The three study groups were homogeneous with respect to age, BMI, gender, and comorbidities. There was a significant reduction in operative time among the groups (p < 0.00001), with a difference of approximately 40 min between the first and third groups. The decrease in operative time was associated with a decrease in the number of stapler firings used per LSG. Conversely, there was no statistical correlation between intraoperative blood loss, intraoperative complications, or weight loss 1-year postsurgery and the LSG learning curve. In addition, the increase in experience with LSG was also associated with a significant reduction (p < 0.00001) in the length of hospital stay. With respect to postoperative complications, a statistically significant difference was recorded between groups B and C (p = 0.02). Finally, a patient undergoing surgery at the end of the LC had an estimated reduction in economic impact of approximately 2700 Euros compared with a patient undergoing surgery at the beginning of the LC.


Approximately 60 cases are required to reach proficiency in reducing postoperative complications and costs of LSG.


Learning curve Laparoscopic sleeve gastrectomy Proficiency Staple firings Operative time Length of hospital stay 


Compliance with Ethical Standards

Conflict of Interests

The authors declare that they have no conflict of interest.

Statement of Informed Consent

For this type of study, formal consent is not required.

Statement of Human Rights

All of the procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki.

Financial or Material Support



  1. 1.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefGoogle Scholar
  2. 2.
    Baltasar A, Serra C, Pérez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obs Surg. 2005;15(8):1124–8.CrossRefGoogle Scholar
  3. 3.
    Akkary E, Duffy A, Bell R. Deciphering the sleeve: technique, indications, efficacy, and safety of sleeve gastrectomy. Obes Surg. 2008;8:1323–9.CrossRefGoogle Scholar
  4. 4.
    Zachariah SK, Chang PC, Se En Ooi A, et al. Laparoscopic sleeve gastrectomy for morbid obesity: 5 years’ experience from an Asian center of excellence. Obes Surg. 2013;23:939–46.CrossRefGoogle Scholar
  5. 5.
    Casella G, Soricelli E, Giannotti D, et al. Learning curve for laparoscopic sleeve gastrectomy: role of training in high-volume bariatric center. Surg Endosc. 2016;30(9):3741–8.CrossRefGoogle Scholar
  6. 6.
    Dey A, Mittal T, Malik VK. Initial experience with laparoscopic sleeve gastrectomy by a novice bariatric team in an established bariatric center. A review of literature and initial results. Obes Surg. 2013;23:541–7.CrossRefGoogle Scholar
  7. 7.
    Prevot F, Verhaeghe P, Pequignot A, et al. Two lessons from a 5-year follow-up study of laparoscopic sleeve gastrectomy: persistent, relevant weight loss and short surgical learning curve. Surgery. 2013;155(2):292–9.CrossRefGoogle Scholar
  8. 8.
    Zacharoulis D, Sioka E, Papamargaritis D, et al. Influence of the learning curve on safety and efficiency of laparoscopic sleeve gastrectomy. Obes Surg. 2012;22:411–5.CrossRefGoogle Scholar
  9. 9.
    Major P, Wysocki M, Dworak J, et al. Analysis of laparoscopic sleeve gastrectomy learning curve and its influence on procedure safety and perioperative complications. Obes Surg. 2017;28:1672–80. CrossRefGoogle Scholar
  10. 10.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefGoogle Scholar
  11. 11.
    Ballantyne GH, Ewing D, Capella RF, et al. The learning curve measured by operating times for laparoscopic and open gastric bypass: roles of surgeon’s experience, institutional experience, body mass index and fellowship training. Obes Surg. 2005;15:172–82.CrossRefGoogle Scholar
  12. 12.
    Shin RB. Evaluation of the learning curve for laparoscopic roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2005;1(2):91–4.CrossRefGoogle Scholar
  13. 13.
    Schauer P, Ikramuddin S, Hamad G, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc. 2003;17:212–5.CrossRefGoogle Scholar
  14. 14.
    Reames BN, Bacal D, Krell RW, et al. Influence of median surgeon operative duration on adverse outcomes in bariatric surgery. Surg Obes Relat Dis. 2015;11(1):207–13.CrossRefGoogle Scholar
  15. 15.
    Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5(4):469–75.CrossRefGoogle Scholar
  16. 16.
    Birkmeyer JD, Finks JF, O’Reilly A, et al. Surgical skill and complication rates after bariatric surgery. N Engl J Med. 2013;369:1434–42.CrossRefGoogle Scholar
  17. 17.
    Rebibo L, Dhahri A, Badaoui R, et al. Laparoscopic sleeve gastrectomy as day-case surgery (without overnight hospitalization). Surg Obes Relat Dis. 2015;11:335–42.CrossRefGoogle Scholar
  18. 18.
    Billing PS, Crouthamel MR, Oling S, et al. Outpatient laparoscopic sleeve gastrectomy in a free-standing ambulatory surgery center: first 250 cases. Surg Obes Relat Dis. 2014;10:101–5.CrossRefGoogle Scholar
  19. 19.
    Khorgami Z, Petrosky JA, Andalib A, et al. Fast track surgery: safety of discharge on the first postoperative day after bariatric surgery. Surg Obes Relat Dis. 2017;13:273–80.CrossRefGoogle Scholar
  20. 20.
    Bohdjalian A, Langher FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–40.CrossRefGoogle Scholar
  21. 21.
    Noel P, Schneck AS, Nedelcu M, et al. Laparoscopic sleeve gastrectomy as a revisional procedure for failed gastric banding: lessons from 300 consecutive cases. Surg Obes Relat Dis. 2014;10:1116–22.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.ELSAN, Clinique Saint MichelCentre Chirurgical de l’Obesité (CCO)ToulonFrance
  2. 2.Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre Intégré Nord Francilien de la prise en charge de l’Obésité (CINFO)Université Paris XIII-UFR SMBH “Léonard de Vinci”BobignyFrance

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