BACKGROUND
The increase in the number of laparoscopic mini-gastric bypass (MGB) in the treatment of obesity is associated with the effectiveness, safety of the intervention, rapid rehabilitation and technically not difficult to perform. The study of mastering the MGB experience remains insufficiently studied.
OBJECTIVE
By constructing cumulative sum learning curves (CUSUM) to study the development of experience and its impact on the features of mini-gastric bypass surgery in the treatment of obesity.
MATERIAL AND METHODS
One doctor performed 341 laparoscopic MGB from 2017 to 2023. The median age of the patients was 40.5 [34;48.3] years. There were 284 (83.2%) women. The median BMI in the operated patients was 45 [40;52] kg/m2. To construct the learning curve and analyze it, the CUSUM function was used, the criterion of experience was undesirable manifestations of operations: the duration of the operation was higher than the sum of the average value and standard deviation for the entire cohort of operated patients (124.2 minutes), postoperative complications in 5 (1.5%) cases and the goal was to reduce the frequency of undesirable manifestations by 2 times.
RESULTS
According to the applied study method, the duration of mastering MGB was 117 operations. At the same time, the intervention time significantly decreased from 120 [110; 130] minutes during the training period to 90 [90;100] during the consolidated experience (p=0.0001) and became significantly more stable (p=0.0001), the complication rate decreased from 1.7% to 1.3% (p=0.788)
CONCLUSION
The application of the method of CUSUM, selected signs of experience and the set goal made it possible to objectify and study the training period for performing MGB, which amounted in duration to a third of all sequentially performed operations by one surgeon. Laparoscopic MGB in the treatment of obese patients is a safe intervention with a relatively long training period-117 operations. The learning process did not affect the safety of the intervention, the frequency of complications during the training period and the achievement of experience did not significantly differ. BMI is an independent significant factor affecting the duration of the mini-bypass surgery. With the acquisition of experience, its impact on the duration of the operation decreases.
