Boss vs. trainee - Who did it better? Can bariatric surgery be taught safely?

---

Preekesh Patel

Waikato Hospital, New Zealand

: J Surg Clin Pract

Abstract

---

Aim: The learning curve for bariatric surgery can deter surgical trainees and fellows from learning procedures such as Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Mini Gastric Bypass (LMGB). We hypothesise that bariatric surgery can be taught safely without compromise in quality, at a moderate volume centre.

Methods: Retrospective collection of prospectively collected data was performed using electronic databases. This included basic demographics, operation type and identification of primary operator (consultant vs trainee), defined as the operator who completed ≥50% of the operation, including gastric staple application. Primary outcomes included 1-year mean %BMI change over one year, 30-day morbidity and mortality. Secondary outcomes included 30-day and 1-year readmission rates.

Results: All 251 bariatric surgeries performed or supervised by a single bariatric surgeon between May 2011 and November 2018 (228 LSG and 23 LMGB) were included. 87/251 (35%) were consultant-led and 164/251 (65%) were trainee-led. There were no staple line leaks, anastomotic leaks or 30-day mortalities. 8/251 (3%) had 30-day morbidity, with 2/87 (2%) occurring with consultant-led cases and 6/164 (4%) with trainee-led cases. 4/251 (2%) were readmitted within 30-days, 1/87 (1%) was a consultantled case and 3/164 (2%) with trainee-led cases. 1-year mean %BMI change was 36% for consultant-led operations and 35% for trainee-led operations. No outcomes exhibited statistical difference based on primary operator status.

Conclusions: Bariatric surgery can be taught safely at a moderate volume centre, without reduction in quality. This data could help promote higher trainee primary operator rates in bariatric centres around New Zealand.

Biography

---

Preekesh Patel completed his Bachelor of Medicine and Bachelor of Surgery from The University of Auckland in 2014. He has a Post-graduate Certificate in Surgical Sciences from The University of Edinburgh. He is currently working at Waikato Hospital as a General Surgery Registrar.

E-mail: preekeshpatel@gmail.com