Perioperative Outcomes of Laparoscopic and Robotic Revisional Bariatric Surgery in a Complex Patient Population

Abstract

Background

Utilization of the robotic platform has become more common in bariatric applications. We aim to show that robotic revisional bariatric surgery (RRBS) can be safely performed in a complex patient population with perioperative outcomes equivalent to laparoscopic revisional bariatric surgery (LRBS).

Methods

Retrospective review was conducted of adult patients undergoing laparoscopic revisional bariatric surgery (LRBS) or robotic revisional bariatric surgery (RRBS) at our institution from September 2007 to December 2016. Patients undergoing planned two-stage bariatric procedures were excluded.

Results

A total of 84 patients who underwent LRBS (n = 66) or RRBS (n = 18) were included. The index operation was adjustable gastric banding (AGB) in 39/84 (46%), sleeve gastrectomy (VSG) in 23/84 (27%), Roux-en-Y gastric bypass (RYGB) in 13/84 (16%), and vertical banded gastroplasty (VBG) in 9/84 (11%). For patients undergoing conversion from AGB (n = 39), there was no difference in operative time, length of stay, or complications by surgical approach. For patients undergoing conversion from a stapled procedure (n = 45), the robotic approach was associated with a shorter length of stay (5.8 ± 3.3 vs 3.7 ± 1.7 days, p = 0.04) with equivalent operative time and post-operative complications. There were three leaks in the LRBS group and none in the RRBS group (p = 0.36). Major complications occurred in 3/39 (8%) of patients undergoing conversion from AGB and 2/45 (4%) of patients undergoing conversion from a stapled procedure (p = 0.53) with no difference by surgical approach.

Conclusions

RRBS is associated with a shorter length of stay than LRBS in complex procedures and has at least an equivalent safety profile. Long-term follow-up data is needed.

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Funding

This study was internally funded.

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Correspondence to Cheguevara Afaneh.

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Conflict of Interest

Dr. Afaneh reports honoraria from Intuitive Surgical, outside the submitted work. Dr. Pomp reports personal fees from WL Gore & Associates and Medtronic Ethicon, outside the submitted work. Dr. Dakin reports personal fees from Medtronic, outside the submitted work. Drs. Gray, Moore, Bellorin, Elmously, and Zarnegar have nothing to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Additional information

Presented as a podium presentation at the annual Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) conference in March 2017

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Gray, K.D., Moore, M.D., Elmously, A. et al. Perioperative Outcomes of Laparoscopic and Robotic Revisional Bariatric Surgery in a Complex Patient Population. OBES SURG 28, 1852–1859 (2018). https://doi.org/10.1007/s11695-018-3119-x

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Keywords

  • Revisional
  • Bariatrics
  • Robotic
  • Laparoscopic
  • Adjustable gastric band
  • Sleeve gastrectomy
  • Roux-en-Y gastric bypass