Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches?

Abstract

ObjectiveThe aim was to compare clinical outcomes of patients treated with totally robotic Roux-en-Y gastric bypass (TRRYGB) with those treated with the different laparoscopic Roux-en-Y gastric bypass (LRYGB) techniques.Summary Background DataThe clinical benefit of the robotic approach to bariatric surgery compared to the standard laparoscopic approach is unclear. There are no studies directly comparing outcomes of TRRYGB with different LRYGB techniques.MethodsOutcomes of 578 obese patients who underwent RYGB between 2011 and 2014 at an academic center were assessed. Multivariable analysis and propensity matching were used for comparing TRRYGB to different LRYGB techniques, including 21-mm EEA circular-stapled gastrojejunal anastomosis (GJA, LRYGB-21CS), linear-stapled GJA (LRYGB-LS), and hand-sewn GJA (LRYGB-HS).ResultsThe TRRYGB technique required a longer mean operative time compared to the other groups, respectively 204 ± 46 vs. 139 ± 30 min (LRYGB-21CS), 206 ± 37 vs. 158 ± 30 min (LRYGB-LS), and 210 ± 36 vs. 167 ± 30 min (LRYGB-HS). TRRYGB experienced a lower stricture rate (2 vs. 17%, P = 0.003), shorter hospital stay (2.6 ± 1.2 vs. 4.3 ± 5.5 days, P = 0.008), and lower readmission rate (12 vs. 28%, P = 0.009). No significant differences in outcomes were observed when comparing RRYGB to LRYGB-LS or LRYGB-HS.ConclusionsTRRYGB increases operative time compared to all LRYGB techniques. TRRYGB was superior to LRYGB-21CS in terms of significantly shorter hospital stay, lower readmission rate, and less frequent GJA stricture formation. TRRYGB provides no clinical advantages over the LRYGB-LS and LRYGB-HS techniques.Electronic supplementary materialThe online version of this article (10.1007/s11695-018-3228-6) contains supplementary material, which is available to authorized users.

Long-term Emergency Department Visits and Readmissions After Laparoscopic Roux-en-Y Gastric Bypass: a Systematic Review

“…Most studies were single-arm studies that reported outcomes only after LRYGB or two-armed studies involving different types of bariatric surgeries. Others were two-armed studies comparing results between Medicaid and non-Medicaid patients [ 23 , 24 ], patients in which a different technique was used to close the gastrojejunostomy [ 30 , 31 , 36 ], or compared private practice versus an academic hospital [ 27 ].…”

“… ** ***** Li, 2015 [ 42 ] *** . *** ****** Rogula, 2018 [ 31 ] *** ** ** ******* Roy, 2017 [ 36 ] *** ** ** ******* Shah, 2016 [ 28 ] *** ** *** ******** Telem, 2014 [ 29 ] *** . ** ***** Waydia, 2014 [ 35 ] *** .…”

“…Within the first 90 days after surgery, the rates of readmission were between 4.1 and 20.5% [ 23 , 24 , 26 , 28 , 30 , 33 , 34 , 36 , 38 – 41 ]. The number of patients readmitted within a 1-year FU ranged from 4.75 to 16.6% [ 31 , 40 – 42 ]. One and a half year readmission was 19.9% [ 37 ] and 2-year readmission was 29% [ 29 ].…”

<p>Comparison Between Robotic and Laparoscopic or Open Anastomoses: A Systematic Review and Meta-Analysis</p>

“…Five studies referring to RYGB were considered for our analysis, which included 2155 adult patients in total (490 men, 1665 women) 10–14. Out of these five studies, one was a prospective randomized trial conducted in the USA comparing robotic with laparoscopic RYGB,14 three were retrospective non-randomized done in the USA comparing again robotic with laparoscopic RYGB,10,11,13 and one was a retrospective non-randomized Swiss study with three treatment arms (robotic, laparoscopic, open) 12…”

The Impact of Robotics in Learning Roux-en-Y Gastric Bypass: a Retrospective Analysis of 214 Laparoscopic and Robotic Procedures

“…Whether these statements are also valid for RRYGB remains to be shown. While most workgroups opted for a robotic hand-sewn anastomosis [8,11,12,[15][16][17][18][19]33], we kept to the well-established technique using the linear stapler. We decided to use an external linear stapler operated by the assistant.…”