Tyler Cohn, MD, Jie Yang, PhD, Jihye Park, MS, Salvatore Docimo, DO, Andrew Bates, MD, Aurora Pryor, MD, Konstantinos Spaniolas, MD. Stony Brook University
Introduction: Current evidence regarding the benefit of robotic (RRYGB) over laparoscopic (LRYGB) gastric bypass is unclear. The aim of this study was to compare 30-day postoperative outcomes of RRYGB and LRYGB.
Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) public use file for 2015 was used to identify patients that underwent gastric bypass. Patients were compared based on surgical approach (laparoscopic or robotic) and type of intervention (primary or revisional). Propensity score matching was used to control for baseline differences in race, American Society of Anesthesiology (ASA) class, age, body mass index (BMI), presence of co-morbidities, functional status, and presence of any complication in order to assess procedural duration, anastomotic/staple line leak, and 30-day events (readmission, re-operation, re-intervention, and mortality).
Results: 42,503 patients were identified that underwent gastric bypass. Of these 35,354 underwent primary LRYGB, 2,869 underwent primary RRYGB, 3,925 underwent revisional LRYGB, and 355 underwent revisional RRYGB. For primary procedures, patients undergoing RRYGB were more likely to be older (mean age 46±17 vs 45±18 years, p <0.0001), white (78.3% vs 76.6%, p<0.0001), and have a lower BMI (44.7±10.4 vs 44.9±10.2 kg/m2, p=0.0299) than the LRYGB group. For revisional procedures, only ASA class (ASA III/IV 74.57% [RRYGB] vs 75.23% [LRYGB], p=0.0003) and pre-operative BMI (40.9±9.9 [RRYGB] vs 41.9±9.8 kg/m2 [LRYGB], p=0.0374) were significantly different between the two groups. 2,858 pairs undergoing primary and 354 pairs undergoing revisional procedures were successfully matched. Robotic gastric bypass was associated with a significantly longer operation length than laparoscopic gastric bypass for both primary (median difference 31 minutes, p<0.0001) and revisional (median difference 47 minutes, p<0.0001) procedures. In patients undergoing primary bypass, there was a trend towards increased 30-day readmission (6.6% vs 5.5%, p=0.0848) and 30-day re-intervention (2.9% vs 2.1%, p=0.0673) rates in the RRYGB group. Overall, there were no significant differences in anastomotic/staple line leak, 30-day readmission, re-operation, re-intervention, total event, and mortality rates between matched cohorts.
Conclusion: When controlling for patient characteristics, those undergoing primary and revisional LRYGB and RRYGB had no difference in early morbidity. Despite the prolonged operative duration, the robotic approach was not associated with any clinical benefit or increased complications for primary or revisional gastric bypass surgery. Further studies are needed to compare long-term outcomes as well as the difference in costs that accompany the combination of longer operation length and use of robotic equipment.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87713
Program Number: P809
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster