Background

As bariatric surgery trends shift toward vertical sleeve gastrectomy (VSG) away from Roux-en-Y gastric bypass (RYGB), adequate fellow training to RYGB is imperative. Identifying a RYGB technique with a quicker learning curve may be beneficial.

Methods

Retrospective review of RYGB performed by three fellows at a teaching hospital over a three-year period from August 2019 to present. RYGB involving fellows performed for weight loss were included. Current techniques include a linear stapler partially handsewn (HS) gastrojejunal (GJ) anastomosis and circular stapled (CS) GJ anastomosis. The aim was to identify a difference between techniques using operative times as surrogates for fellow learning curves.

Results

Of 142 cases reviewed, 18 were excluded. Average operative times for RYGB for CS GJ were shorter compared to HS GJ, 188min (CS) vs. 284min (HS), p=0.002. By the second academic quarter, CS GJ operative times decreased by 9% compared to an increased operative time of 9% by the fourth quarter for HS GJ. Adding 29 revisional cases (VSG to RYGB), demonstrated shorter operative times in CS GJ comparatively, 190min (CS) vs. 281min (HS), p=0.005.

Conclusions

CS GJ has a quicker learning curve translating into shorter operative times and has been adopted as the technique of choice following fellowship. HS GJ has a steeper learning curve; however, there is value in learning additional techniques given patient factors may prevent a CS GJ technique. Implementing a RYGB technique with a shorter learning curve to reach proficiency earlier in the year may be of value in fellow training.