Robotic vs laparoscopic approach for single anastomosis duodenal-ileal bypass with sleeve gastrectomy: a propensity score matching analysis

Abstract

Biliopancreatic diversion with duodenal switch and single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) are technically demanding hypo-absorptive bariatric procedures. They are often indicated in superobese patients (BMI ≥ 50 kg/m2), as robotic platform could improve ergonomics against a thick abdominal wall, preventing bending of instruments and simplifying hand-sewn anastomoses. We aimed to report our experience with robotic SADI-S (R-group) and to compare outcomes with the laparoscopic (L-group) approach. Among 2143 patients who underwent bariatric procedures at our institution between July 2016 and June 2021, 116 (5.4%) consenting patients were scheduled for SADI-S as primary or revisional procedure: 94 L-group, 22 R-group. R-group and L-group patients were matched using PSM analysis to overcome patients selection bias. Postoperative complications, operative time (OT), post-operative stay (POS) and follow-up data were compared. After PSM, 44 patients (22 patients for each group) were compared (Chi-square 0.317, p = 0.985). Median age, gender, median BMI, preoperative rates of comorbidities, previous abdominal bariatric and non-bariatric surgeries and type of surgical procedures (SADI-S/SADI) were comparable. Median OT was shorter in the L-group (130 Vs 191 min, p < 0.001). 30-days’ re-operative complications and late complications rates were comparable. At 25-months’ mean follow-up, the median Percentage Excess Weight Loss (72%) was comparable between the groups (p = 0.989). L-group and R-group were comparable in terms of re-operative complication rate and short-term outcomes. The robotic platform may increase the rate of single step procedure in challenging cases. Larger studies with longer follow-up and cost-analysis are necessary to draw definitive conclusions.

Cost-effectiveness and outcomes of robot-assisted vs laparoscopic bariatric procedures in super obese patients: a propensity score matching analysis from a high- volume center

“…As a matter of fact, some studies speci cally underlined that the docking step is responsible for a signi cant increase of OT [32,33]. In our previously experience we underlined that despite robotic technology-associated longer OT, surgical complications are comparable to laparoscopy [14].…”

“…We also showed that, when cases series on a long-time period are considered, differences among laparoscopic and robot-assisted procedures in terms of hospital stay may be explained by variation of clinical protocol (e.g. ERAS fast track protocol), distance between hospital and patients' home and cultural behaviour [14].…”

“…Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) was introduced as an alternative to BPD/DS with the aim of simplifying the surgical steps, thus maintaining the bariatric and metabolic outcomes, with promising late (10 years) results [13]. SADI-S is primarily indicated for "complex" bariatric patients, including those ones with a BMI of 50 kg/m 2 or higher, metabolic patients and those requiring revisional surgery [14,15]. Conventional laparoscopy poses technical limitations which are further exacerbated when dealing with obese and particularly SO patients.…”

Feasibility of Roux-en-Y Gastric Bypass with the novel robotic platform HUGO™ RAS

“…Patients were discharged 24 h after the surgical procedure if the following conditions were met: no clinical complications or postoperative biochemical and imaging alterations occurred; oral alimentation was tolerated; autonomous in life activities; the discharge was accepted by the patient. The complete post-operative and follow-up protocol has been previously described in detail and is beyond the scope of this study ( 24 , 25 ).…”

Medium-Term Nutritional and Metabolic Outcome of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S)

“…A standardized postoperative protocol tailored to bariatric patients was used [ 10 , 12 ]. The severity of postoperative complications was graded according to the Clavien-Dindo classification [ 13 ].…”