Perioperative safety of laparoscopic versus robotic gastric bypass: a propensity matched analysis of early experience

Abstract

Background: The role of robotic assistance for gastric bypass remains controversial. Using a large nationwide cohort, we compared early outcomes after robotic Roux-en-Y gastric bypass (Robot-RYGB) with the laparoscopic technique (LRYGB).

Objective: This study aimed to use a bariatric-specific, large, nationwide cohort with several years of data to compare the early postoperative outcomes of the Robot-RYGB and LRYGB.

Setting: Nationwide register-based cohort study.

Methods: The Bariatric Outcomes Longitudinal Database from 2007 to 2012 was used to identify patients who underwent nonrevisional Robot-RYGB or LRYGB. Propensity matching was used to account for differences in age, body mass index, sex, American Society of Anesthesiologists classification, multiple preoperative co-morbidities, and procedural year. A second propensity score was calculated with adjustment of operative time in addition to the other adjusted variables.

Results: We identified 137,455 patients who underwent Robot-RYGB (n = 2415) or LRYGB (n = 135,040) with a mean body mass index of 47.1 ± 8.4 kg/m² and age of 45.4 ± 11.7 years. In the propensity-matched cohorts, there were 30-day differences in operative time (150.2 ± 72.5 versus 111.8 ± 47.6, P<.001); 30-day rates of reoperation (4.8% versus 3.1%, P = .002); 90-day rates of reoperation (8.8% versus 5.3%, P<.001), complication (15.8% versus 12.5%, P = .001), readmission (8.5% versus 6.4%, P = .005), stricture (3.5% versus 2.0%, P = .001), ulceration (1.2% versus .6%, P = .034), nausea or emesis (6.4% versus 4.36%, P = .001), and anastomotic leak (1.6% versus .2%, P<.001) when comparing Robot-RYGB with LRYGB. After including operative time in propensity matching, there were no significant differences in rates of 30-day readmission or ulceration or 90-day readmission or ulceration; all other differences remained significant.

Conclusions: Despite controlling for patient characteristics, patients undergoing Robot-RYGB developed higher rates of early morbidity compared with LRYGB, suggesting LRYGB may provide improved postoperative outcomes. Further studies are needed to definitively compare these 2 operative approaches.

Keywords: BOLD; Bariatric surgery; Gastric bypass; Robotic surgery.