Impact of a bariatric surgery fellowship program on the incidence of surgical complications.

BACKGROUND

The rising prevalence of obesity in Mexico has increased the demand for Metabolic & bariatric surgery, a technically complex procedure that requires rigorous surgical training to ensure patient safety. This study evaluates the safety and efficacy of bariatric procedures performed by surgical fellows acting as primary surgeons under direct supervision, within a structured fellowship program incorporating simulation training and stepwise autonomy at a private teaching hospital.

METHODS

A retrospective analysis was conducted on 93 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2012 and 2023. All procedures were performed by fellows under direct supervision. Outcomes assessed included operative time, complication rates, readmissions, and weight loss, and were compared to a matched cohort operated on by staff surgeons, as well as to benchmark data from NSQIP and MBSAQIP databases.

RESULTS

The cohort included 76 females and 17 males, with a mean BMI of 42.6 ± 12.1 kg/m2. There were no mortalities, ICU admissions, or conversions to open surgery. Mean operative time was 187.4 min. Major complications occurred in 6.4% (6/93) of patients, with 3.2% requiring reoperation. One-year excess weight loss was 76 ± 18.8%. Compared to the control group and benchmark databases, only operative time was significantly longer.

CONCLUSION

Metabolic/bariatric surgery performed by fellows within a structured and supervised training program is safe and effective. Although operative times were longer, patient outcomes were not compromised.