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

Katherine D Gray, MD¹, Maureen D Moore, MD¹, Suraj Panjwani, MBBS², Omar Bellorin, MD¹, Adham Elmously, MD¹, Rasa Zarnegar, MD¹, Gregory Dakin, MD¹, Alfons Pomp, MD¹, Cheguevara Afaneh, MD¹. ¹New York Presbyterian Hospital-Weill Cornell Medicine, ²Weill Cornell Medicine

INTRODUCTION: Utilization of the robotic platform has gained increasing success in bariatric applications. In thisstudy, we examine the role of the robotic platform in a surgically complex group of patients undergoing revisional bariatric procedures.

METHODS AND PROCEDURES: A retrospective review was conducted of all adult patients undergoing laparoscopic revisional bariatric surgery (LRBS) or robotic revisional bariatric surgery (RRBS) at our institution from September 2007 to August 2016. Patients undergoing planned two-stage bariatric procedures were excluded. Preoperative parameters including demographics, body mass index (BMI), ASA score, prior bariatric procedures, and reason for revision were collected. Perioperative outcomes such as operative time, estimated blood loss (EBL), length of stay (LOS), and morbidity were analyzed. The primary outcome was enteric leak. Secondary outcomes were operative time, morbidity, and length of stay.

RESULTS: A total of 78 patients were included: 66 patients underwent LRBS, and 12 patients underwent RRBS. These groups were comparable with respect to demographics, BMI, and ASA score (Table 1). The majority (45/78, 57.7%) of all patients underwent revisional surgery for insufficient weight loss; the remaining patients were revised for anastomotic complications, reflux, or severe intolerance to oral intake. The index operation was adjustable gastric banding in 38/78 (48.7%), sleeve gastrectomy in 18/78 (23.1%), Roux-en-Y gastric bypass (RYGB) in 13/78 (16.7%), and vertical banded gastroplasty in 9/78 (11.5%). Almost half (37/78, 47.4%) of these patients had undergone at least two prior bariatric procedures. Most patients were converted to sleeve gastrectomy (26/78, 33.3%) or RYGB (49/78, 62.8%). There was no statistical difference in primary or secondary outcomes between LRBS or RRBS groups (Table 2). Enteric leaks occurred in 3/78 (3.8%) patients; all of these occurred in the LRBS group. Operative time was 207 minutes and 209 minutes for LRBS and RRBS respectively, and median length of stay was 4 days for both groups. Complications in the first 30 days occurred in 13/66 (20.0%) of LRBS patients and in 3/12 (25.0%) of RRBS patients; the majority of these (11/16, 67.8%) were considered minor in the Clavien-Dindo classification.

CONCLUSIONS: The robotic platform is a promising tool for complex revisional bariatric operations. In this series, we demonstrate its safety and feasibility in a technically challenging group of patients without an increase in enteric leak rate, morbidity, operative time, or length of stay. Long-term followup is needed to assess longitudinal outcomes.