Comparison of Robotic versus Laparoscopic Revisional Bariatric Surgery

James L Taggart, MD, Julio Teixeira, MD. Lenox Hill Hospital

Background: The population of patients with bariatric surgery is increasing. A number of these patients are seeking revisional bariatric surgery (RBS). Robotic surgery has been used as a tool to tackle these technically complex operations. Our study examines the outcomes of robotic revisional bariatric surgery versus the traditional laparoscopic approach.

Methods:  A prospective data base was utilized to analyze all patients from September, 2013 to September, 2015 who had revisional bariatric surgery. A total of 28 patients were identified (11 robotic, 17 laparoscopic, 0 open). All the patients had a conversion to either a robotic revisional roux-Y-gastric bypass (RRYGB) or laparoscopic revisional roux-Y-gastric bypass (LRYGB). These charts were then reviewed retrospectively and the outcomes reported.

Results:  In the RRYGB group there were two complications, both required endoscopic dilation of a stricture at the gastro-jejunal anastamosis, compared to zero complications in the laparoscopic group (18% versus 0 %).  The operative time for the RRYGB was significantly longer then the LRYGB (376 minutes versus 228 minutes; P = 0.003). The number of hospital days was longer in the laparoscopic group, but did not reach statistical significance (2.92 days versus 2.36 days; P =0.3). There were no conversions to open surgery.

Conclusions: Robotic revisional bariatric surgery is safe and effective, but comes at the cost of longer operative times. In our study, the RRYGB procedure was on average 148 minutes longer, however, there was a tendency towards a shortened hospital stay. Further study is needed with larger sample sizes to define superiority of either operative approach in revisional bariatric surgery.

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