Does fellow participation in laparoscopic Roux-en-Y gastric bypass affect perioperative outcomes?
Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) requires specialized training commonly acquired during a fellowship. We hypothesized that fellows affect patient outcomes and this effect varies during training. Methods We included all LRYGB from the 2005 to 2009 American College of Surgeons-...
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| Veröffentlicht in: | Surgical endoscopy 2012-12, Vol.26 (12), p.3442-3448 |
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| description | Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) requires specialized training commonly acquired during a fellowship. We hypothesized that fellows affect patient outcomes and this effect varies during training.
Methods
We included all LRYGB from the 2005 to 2009 American College of Surgeons-National Surgical Quality Improvement Program database. Cases without trainees (attending) were compared to those with trainees of ≥6 years (fellow). Outcomes were pulmonary, infectious, and wound complications and deep venous thrombosis (DVT). Multivariable regression controlled for age, BMI, and comorbidities.
Results
Of the 18,333 LRYGB performed, 4,349 (24 %) were fellow cases. Fellow patients had a higher BMI (46.1 vs. 45.7,
p
|
| doi_str_mv | 10.1007/s00464-012-2360-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1220368144</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2823742061</sourcerecordid><originalsourceid>FETCH-LOGICAL-c402t-c35904d8577336ab2a43bf7d948987be1fee3fd86380b169f397733dc9502be43</originalsourceid><addsrcrecordid>eNp1kE1rFTEUhkOx2NvqD3AjASm4ic3XZJKVSGtVKBSKLlyFTCYpKXMnY86M9v775nKvVQrdJOTkeU9OHoTeMPqBUdqeAaVSSUIZJ1woSjYHaMWkqCfO9Au0okZQwlsjj9AxwB2tuGHNS3TEuZKacblC7iIHwDEMQ_6DJ1fm5NPk5pRHnEY8uFrK4POUPL7Jyz0JI_mJbx3MpVa6zeQAsIsx-BlPoaRcl5r-HXBeZp_XAT6-QofRDRBe7_cT9OPy8_fzr-Tq-su3809XxEvKZ-JFY6jsddO2QijXcSdFF9veSG102wUWQxCx10po2jFlojBbsvemobwLUpyg97u-U8m_lgCzXSfw9WNuDHkByzinQmkmt-i7J-hdXspYp7OMmZYq1fKmUmxH-aoASoh2KmntysYyarf-7c6_rf7t1r_d1MzbfeelW4f-MfFXeAVO94AD74ZY3OgT_OOU1o02onJ8x0G9Gm9D-W_EZ19_AFncnXs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1197066725</pqid></control><display><type>article</type><title>Does fellow participation in laparoscopic Roux-en-Y gastric bypass affect perioperative outcomes?</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Bhayani, Neil H. ; Gupta, Aditya ; Kurian, Ashwin A. ; Dunst, Christy M. ; Sharata, Ahmed H. ; Reavis, Kevin M. ; Swanstrom, Lee L. ; Halpin, Valerie J.</creator><creatorcontrib>Bhayani, Neil H. ; Gupta, Aditya ; Kurian, Ashwin A. ; Dunst, Christy M. ; Sharata, Ahmed H. ; Reavis, Kevin M. ; Swanstrom, Lee L. ; Halpin, Valerie J.</creatorcontrib><description>Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) requires specialized training commonly acquired during a fellowship. We hypothesized that fellows affect patient outcomes and this effect varies during training.
Methods
We included all LRYGB from the 2005 to 2009 American College of Surgeons-National Surgical Quality Improvement Program database. Cases without trainees (attending) were compared to those with trainees of ≥6 years (fellow). Outcomes were pulmonary, infectious, and wound complications and deep venous thrombosis (DVT). Multivariable regression controlled for age, BMI, and comorbidities.
Results
Of the 18,333 LRYGB performed, 4,349 (24 %) were fellow cases. Fellow patients had a higher BMI (46.1 vs. 45.7,
p
< 0.001) and fewer comorbidities. Mortality was 0.2 and 0.1 % and overall morbidity was 4.8 and 6.0 % for attending and fellow groups, respectively. On adjusted analysis, mortality was similar, but fellow cases had 30 % more morbidity (
p
= 0.001). Specifically, fellows increased the odds of superficial surgical site infections (SSSIs) [odds ratio (OR) = 1.4,
p
= 0.01], urinary infections (UTIs) (OR = 1.7,
p
= 0.002), and sepsis (OR = 1.5,
p
= 0.05). During the first 6 months, fellows increased the odds of DVT (OR = 4.7,
p
= 0.01), SSIs (OR = 1.5,
p
= 0.001), UTIs (OR = 1.8,
p
= 0.004), and sepsis (OR = 1.9,
p
= 0.008). By the second half of training, fellow cases demonstrated outcomes equivalent to attending cases.
Conclusions
Involving fellows in LRYGB may increase DVT, SSIs, UTIs, and sepsis, especially early in training. By completion of their training, cases involving fellows exhibited outcomes similar to cases without trainees. This supports both the need for fellowship training in bariatric surgery and the success of training to optimize patient outcomes.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-012-2360-y</identifier><identifier>PMID: 22648124</identifier><identifier>CODEN: SUREEX</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Biological and medical sciences ; Cardiovascular disease ; Chronic obstructive pulmonary disease ; Clinical Competence ; Clinical outcomes ; Digestive system. Abdomen ; Endoscopy ; Fellowships and Scholarships ; Female ; Gastric Bypass - education ; Gastric Bypass - methods ; Gastric Bypass - standards ; Gastroenterology ; Gastrointestinal surgery ; Gynecology ; Hepatology ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Laparoscopy ; Laparoscopy - education ; Laparoscopy - standards ; Learning curves ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Metabolic diseases ; Middle Aged ; Morbidity ; Mortality ; Obesity ; Patients ; Pneumonia ; Proctology ; Quality improvement ; Retrospective Studies ; Scholarships & fellowships ; Sepsis ; Stomach, duodenum, intestine, rectum, anus ; Surgeons ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Surgical outcomes ; Surgical site infections ; Thrombosis ; Treatment Outcome ; Urinary tract infections ; Weight control</subject><ispartof>Surgical endoscopy, 2012-12, Vol.26 (12), p.3442-3448</ispartof><rights>Springer Science+Business Media, LLC 2012</rights><rights>2014 INIST-CNRS</rights><rights>Springer Science+Business Media New York 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c402t-c35904d8577336ab2a43bf7d948987be1fee3fd86380b169f397733dc9502be43</citedby><cites>FETCH-LOGICAL-c402t-c35904d8577336ab2a43bf7d948987be1fee3fd86380b169f397733dc9502be43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-012-2360-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-012-2360-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26885893$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22648124$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bhayani, Neil H.</creatorcontrib><creatorcontrib>Gupta, Aditya</creatorcontrib><creatorcontrib>Kurian, Ashwin A.</creatorcontrib><creatorcontrib>Dunst, Christy M.</creatorcontrib><creatorcontrib>Sharata, Ahmed H.</creatorcontrib><creatorcontrib>Reavis, Kevin M.</creatorcontrib><creatorcontrib>Swanstrom, Lee L.</creatorcontrib><creatorcontrib>Halpin, Valerie J.</creatorcontrib><title>Does fellow participation in laparoscopic Roux-en-Y gastric bypass affect perioperative outcomes?</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) requires specialized training commonly acquired during a fellowship. We hypothesized that fellows affect patient outcomes and this effect varies during training.
Methods
We included all LRYGB from the 2005 to 2009 American College of Surgeons-National Surgical Quality Improvement Program database. Cases without trainees (attending) were compared to those with trainees of ≥6 years (fellow). Outcomes were pulmonary, infectious, and wound complications and deep venous thrombosis (DVT). Multivariable regression controlled for age, BMI, and comorbidities.
Results
Of the 18,333 LRYGB performed, 4,349 (24 %) were fellow cases. Fellow patients had a higher BMI (46.1 vs. 45.7,
p
< 0.001) and fewer comorbidities. Mortality was 0.2 and 0.1 % and overall morbidity was 4.8 and 6.0 % for attending and fellow groups, respectively. On adjusted analysis, mortality was similar, but fellow cases had 30 % more morbidity (
p
= 0.001). Specifically, fellows increased the odds of superficial surgical site infections (SSSIs) [odds ratio (OR) = 1.4,
p
= 0.01], urinary infections (UTIs) (OR = 1.7,
p
= 0.002), and sepsis (OR = 1.5,
p
= 0.05). During the first 6 months, fellows increased the odds of DVT (OR = 4.7,
p
= 0.01), SSIs (OR = 1.5,
p
= 0.001), UTIs (OR = 1.8,
p
= 0.004), and sepsis (OR = 1.9,
p
= 0.008). By the second half of training, fellow cases demonstrated outcomes equivalent to attending cases.
Conclusions
Involving fellows in LRYGB may increase DVT, SSIs, UTIs, and sepsis, especially early in training. By completion of their training, cases involving fellows exhibited outcomes similar to cases without trainees. This supports both the need for fellowship training in bariatric surgery and the success of training to optimize patient outcomes.</description><subject>Abdominal Surgery</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular disease</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Clinical Competence</subject><subject>Clinical outcomes</subject><subject>Digestive system. Abdomen</subject><subject>Endoscopy</subject><subject>Fellowships and Scholarships</subject><subject>Female</subject><subject>Gastric Bypass - education</subject><subject>Gastric Bypass - methods</subject><subject>Gastric Bypass - standards</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Laparoscopy</subject><subject>Laparoscopy - education</subject><subject>Laparoscopy - standards</subject><subject>Learning curves</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic diseases</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Obesity</subject><subject>Patients</subject><subject>Pneumonia</subject><subject>Proctology</subject><subject>Quality improvement</subject><subject>Retrospective Studies</subject><subject>Scholarships & fellowships</subject><subject>Sepsis</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Surgical outcomes</subject><subject>Surgical site infections</subject><subject>Thrombosis</subject><subject>Treatment Outcome</subject><subject>Urinary tract infections</subject><subject>Weight control</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kE1rFTEUhkOx2NvqD3AjASm4ic3XZJKVSGtVKBSKLlyFTCYpKXMnY86M9v775nKvVQrdJOTkeU9OHoTeMPqBUdqeAaVSSUIZJ1woSjYHaMWkqCfO9Au0okZQwlsjj9AxwB2tuGHNS3TEuZKacblC7iIHwDEMQ_6DJ1fm5NPk5pRHnEY8uFrK4POUPL7Jyz0JI_mJbx3MpVa6zeQAsIsx-BlPoaRcl5r-HXBeZp_XAT6-QofRDRBe7_cT9OPy8_fzr-Tq-su3809XxEvKZ-JFY6jsddO2QijXcSdFF9veSG102wUWQxCx10po2jFlojBbsvemobwLUpyg97u-U8m_lgCzXSfw9WNuDHkByzinQmkmt-i7J-hdXspYp7OMmZYq1fKmUmxH-aoASoh2KmntysYyarf-7c6_rf7t1r_d1MzbfeelW4f-MfFXeAVO94AD74ZY3OgT_OOU1o02onJ8x0G9Gm9D-W_EZ19_AFncnXs</recordid><startdate>20121201</startdate><enddate>20121201</enddate><creator>Bhayani, Neil H.</creator><creator>Gupta, Aditya</creator><creator>Kurian, Ashwin A.</creator><creator>Dunst, Christy M.</creator><creator>Sharata, Ahmed H.</creator><creator>Reavis, Kevin M.</creator><creator>Swanstrom, Lee L.</creator><creator>Halpin, Valerie J.</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20121201</creationdate><title>Does fellow participation in laparoscopic Roux-en-Y gastric bypass affect perioperative outcomes?</title><author>Bhayani, Neil H. ; Gupta, Aditya ; Kurian, Ashwin A. ; Dunst, Christy M. ; Sharata, Ahmed H. ; Reavis, Kevin M. ; Swanstrom, Lee L. ; Halpin, Valerie J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c402t-c35904d8577336ab2a43bf7d948987be1fee3fd86380b169f397733dc9502be43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Abdominal Surgery</topic><topic>Biological and medical sciences</topic><topic>Cardiovascular disease</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Clinical Competence</topic><topic>Clinical outcomes</topic><topic>Digestive system. Abdomen</topic><topic>Endoscopy</topic><topic>Fellowships and Scholarships</topic><topic>Female</topic><topic>Gastric Bypass - education</topic><topic>Gastric Bypass - methods</topic><topic>Gastric Bypass - standards</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Laparoscopy</topic><topic>Laparoscopy - education</topic><topic>Laparoscopy - standards</topic><topic>Learning curves</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic diseases</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Obesity</topic><topic>Patients</topic><topic>Pneumonia</topic><topic>Proctology</topic><topic>Quality improvement</topic><topic>Retrospective Studies</topic><topic>Scholarships & fellowships</topic><topic>Sepsis</topic><topic>Stomach, duodenum, intestine, rectum, anus</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Surgical outcomes</topic><topic>Surgical site infections</topic><topic>Thrombosis</topic><topic>Treatment Outcome</topic><topic>Urinary tract infections</topic><topic>Weight control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bhayani, Neil H.</creatorcontrib><creatorcontrib>Gupta, Aditya</creatorcontrib><creatorcontrib>Kurian, Ashwin A.</creatorcontrib><creatorcontrib>Dunst, Christy M.</creatorcontrib><creatorcontrib>Sharata, Ahmed H.</creatorcontrib><creatorcontrib>Reavis, Kevin M.</creatorcontrib><creatorcontrib>Swanstrom, Lee L.</creatorcontrib><creatorcontrib>Halpin, Valerie J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bhayani, Neil H.</au><au>Gupta, Aditya</au><au>Kurian, Ashwin A.</au><au>Dunst, Christy M.</au><au>Sharata, Ahmed H.</au><au>Reavis, Kevin M.</au><au>Swanstrom, Lee L.</au><au>Halpin, Valerie J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does fellow participation in laparoscopic Roux-en-Y gastric bypass affect perioperative outcomes?</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2012-12-01</date><risdate>2012</risdate><volume>26</volume><issue>12</issue><spage>3442</spage><epage>3448</epage><pages>3442-3448</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><coden>SUREEX</coden><abstract>Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) requires specialized training commonly acquired during a fellowship. We hypothesized that fellows affect patient outcomes and this effect varies during training.
Methods
We included all LRYGB from the 2005 to 2009 American College of Surgeons-National Surgical Quality Improvement Program database. Cases without trainees (attending) were compared to those with trainees of ≥6 years (fellow). Outcomes were pulmonary, infectious, and wound complications and deep venous thrombosis (DVT). Multivariable regression controlled for age, BMI, and comorbidities.
Results
Of the 18,333 LRYGB performed, 4,349 (24 %) were fellow cases. Fellow patients had a higher BMI (46.1 vs. 45.7,
p
< 0.001) and fewer comorbidities. Mortality was 0.2 and 0.1 % and overall morbidity was 4.8 and 6.0 % for attending and fellow groups, respectively. On adjusted analysis, mortality was similar, but fellow cases had 30 % more morbidity (
p
= 0.001). Specifically, fellows increased the odds of superficial surgical site infections (SSSIs) [odds ratio (OR) = 1.4,
p
= 0.01], urinary infections (UTIs) (OR = 1.7,
p
= 0.002), and sepsis (OR = 1.5,
p
= 0.05). During the first 6 months, fellows increased the odds of DVT (OR = 4.7,
p
= 0.01), SSIs (OR = 1.5,
p
= 0.001), UTIs (OR = 1.8,
p
= 0.004), and sepsis (OR = 1.9,
p
= 0.008). By the second half of training, fellow cases demonstrated outcomes equivalent to attending cases.
Conclusions
Involving fellows in LRYGB may increase DVT, SSIs, UTIs, and sepsis, especially early in training. By completion of their training, cases involving fellows exhibited outcomes similar to cases without trainees. This supports both the need for fellowship training in bariatric surgery and the success of training to optimize patient outcomes.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>22648124</pmid><doi>10.1007/s00464-012-2360-y</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Biological and medical sciences Cardiovascular disease Chronic obstructive pulmonary disease Clinical Competence Clinical outcomes Digestive system. Abdomen Endoscopy Fellowships and Scholarships Female Gastric Bypass - education Gastric Bypass - methods Gastric Bypass - standards Gastroenterology Gastrointestinal surgery Gynecology Hepatology Humans Investigative techniques, diagnostic techniques (general aspects) Laparoscopy Laparoscopy - education Laparoscopy - standards Learning curves Male Medical sciences Medicine Medicine & Public Health Metabolic diseases Middle Aged Morbidity Mortality Obesity Patients Pneumonia Proctology Quality improvement Retrospective Studies Scholarships & fellowships Sepsis Stomach, duodenum, intestine, rectum, anus Surgeons Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Surgical outcomes Surgical site infections Thrombosis Treatment Outcome Urinary tract infections Weight control |
| title | Does fellow participation in laparoscopic Roux-en-Y gastric bypass affect perioperative outcomes? |
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