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Laparoscopic Sleeve Gastrectomy Learning Curve: Clinical and Economical Impact

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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

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Authors and Affiliations

  1. ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obesité (CCO), 8300, Toulon, France

    Sergio Carandina, Marc Danan, Viola Zulian & Marius Nedelcu

  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”, route de Stalingrad, Bobigny, France

    Laura Montana & Christophe Barrat

Authors
  1. Sergio Carandina
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  2. Laura Montana
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  4. Viola Zulian
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Correspondence to Sergio Carandina.

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The authors declare that they have no conflict of interest.

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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.

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Carandina, S., Montana, L., Danan, M. et al. Laparoscopic Sleeve Gastrectomy Learning Curve: Clinical and Economical Impact. OBES SURG 29, 143–148 (2019). https://doi.org/10.1007/s11695-018-3486-3

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  • DOI: https://doi.org/10.1007/s11695-018-3486-3

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