Assessing the Learning Process of Laparoscopic Sleeve Gastrectomy with Different Approaches.

Objective:  To determine the learning curve (LC) of laparoscopic sleeve gastrectomy (LSG) based on an excess weight loss (EWL).

Study Design: Observational study.

Place And Duration Of Study: Ondokuz Mayis University, Faculty of Medicine, Department of General Surgery, from December 2012 to April 2018.

Methodology: Data of patients, who were admitted to the general surgery clinic of a tertiary care hospital and underwent LSG, were retrospectively analysed. Three hundred and twenty-five patients, who had completed at least three months of follow-up after their operations, were included in the study. Patients were divided into three groups according to the number of cases in which the lowest expected EWL values were achieved in the postoperative 3, 6, 12 and 24 months as per literature. Comorbidities, complications, duration of surgery and hospital stay were also evaluated in these groups.

Results: The groups were homogeneous in terms of age and body mass index. Group 3 had a significantly higher median EWL when compared to the other two groups (p <0.001). There was a statistically significant difference between Group 2 and Group 3 in terms of diabetes mellitus and remission of thyroid function tests (p = 0.013 and p=0.017, respectively). There were 40 minutes difference in operating time and two-day difference in hospital stay between the median values of Group 1 and Group 3 (p <0.001).

Conclusion: LSG can be safely performed even in centres that have just started bariatric/metabolic surgical operations. Although proficiency seems to require at least 40 cases, more than 80 operations are needed to complete the LC and achieve ideal results. Key Words: Bariatric surgery, Learning curve, Metabolic surgery, Laparoscopic sleeve gastrectomy (LSG).