Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed bariatric surgeries. The steep associated learning curve is dependent on the training facility, laparoscopic experience, and overall procedural volume. William Beaumont Army Medical Center (WBAMC) has been accredited as a bariatric center of excellence and trains resident surgeons in the performance of RYGB. Objective: This study aimed to investigate the accuracy and precision of a bariatric center of excellence's training of surgical residents in terms of laparoscopic measurements of simulated small bowel. This will act as a surrogate for how well surgical residents learn to run the small bowel during bariatric procedures and how their accuracy and precision change over time in training. Setting: This study took place at William Beaumont Army Medical Center, a bariatric center of excellence and training institution. Methods: Participants included surgical residents from WBAMC. Participants used a laparoscopic trainer and two bowel graspers to measure both a collapsing garden hose (simulated bowel) and a nylon rope (control material) to 75 cm (cm) and 125 cm (cm), three times each, with recordings of time required to do so, actual distance measured, and technique used. Results: Fifteen residents participated in the study. Residents displayed accuracy of 21.6 %. 33%of residents were precise for the 75 cm measurement, and 53 % of residents were precise for the 125-cm measurement. PGY-4 residents were the most accurate while PGY-3 residents were the most precise. There were no statistical differences between junior (PGY 1-4) and senior residents (PGY 5-6) in accuracy or precision in the measurement of 75-cm or 125-cm. No statistical differences were found measuring the hose versus rope in accuracy nor precision. PGY-4 residents completed the task in the least amount of time while PGY-2 residents took the longest to complete each task. Conclusions: In general, residents are neither precise nor accurate in measurements of simulated bowel lengths, and experience does not contribute to either. Time in residency correlates with laparoscopic speed but not with accuracy nor precision. Extrapolating this data to attending surgeons suggests that estimated lengths of small bowel that are 'run' or measured during laparoscopic cases are neither accurate nor precise. More investigation must be performed in this area.

BACKGROUND:Adequate long-term follow-up after metabolic and bariatric surgery (MBS) remains a challenge. OBJECTIVES:To evaluate if type of insurance correlated with differences in the 5-year follow-up and outcomes of a cohort of bariatric surgery patients in a community-based accredited center. SETTING:Accredited private practice bariatric center in the United States. METHODS:We studied bariatric surgery patients that underwent MBS in 2015 by a single surgeon in an accredited, community practice. Electronic medical records were utilized to evaluate 5-year follow-up and outcomes data. This included demographics, type of insurance, number of follow-up visits, height, weight, body mass index (BMI), postbariatric procedures, and postbariatric emergency department (ED) utilization. RESULTS:There were 89 patients. The follow-up rate decreased over time, with 1% of patients at 5 years. There was a slightly higher follow-up rate in patients with commercial versus public insurance. The average BMI of patients that followed up decreased by 13.6 kg/m2 over the first postoperative year. The average number of ED visits was 1.46 (standard deviation: 2.38) overall; however, of the 89 total patients, 35 patients (39.3%) had no documented ED visits, with the remaining 61 patients (63.5%) ranging from 1-15 visits (median = 1). CONCLUSION:Overall follow-up rates were low with 4-year follow-up being 14% and 5-year follow-up being <1%. Publicly insured patients had a higher rate of follow-up. Despite low follow-up rates with the actual bariatric surgery practice, 63.5% of patients had an ED visit during the follow-up period.