Roux-en-Y gastric bypass for super obese patients: what approach?

Nicolas C Buchs, MD, Dan Azagury, MD, Francois Pugin, MD, Minoa Jung, MD, Olivier Huber, MD, Gilles Chassot, MD, Philippe Morel, MD. Department of Surgery, University Hospital of Geneva.

Background: Super obese (SO) patients with a Body Mass Index (BMI) ≥ 50 kg/m2 still represent a real anesthesiological and surgical challenge. While the best procedure to perform in this population remains unclear, robotic technology has been proposed to accomplish Roux-en-Y gastric bypass (RYGB). The study aim is to report our experience of robotic RYGB for SO and to compare it to open and laparoscopic surgery.

Methods: From July 1997 to March 2013, all the consecutive RYGB for SO have been prospectively collected in a dedicated database and reviewed retrospectively. One hundred and ninety-nine SO patients were operated on: 51 by a robotic approach (25.6%), 53 by a laparoscopic approach (26.6%), and 95 using an open approach (47.7%). Peri- and post-operative data has been compared between the three approaches.

Results: There were more male patients in the robotic group, but with a slightly lower BMI. The operative time was longer for the robotic (+28 minutes) and laparoscopic (+22 minutes) groups in comparison to the open group (p<0.05). Overall, there were less conversions (p=0.16), less postoperative complications (p>0.05), less reoperations (p<0.05), and a shorter hospital stay (p<0.05) in the robotic group, in comparison to other groups.

Conclusions: Robotic RYGB can be performed safely in super obese patients, with results that compare favorably to laparoscopic and open surgery. However, the robotic approach has a longer operative time. The exact role of robotics for super obese population needs to be clarified in larger and randomized trials before drawing definitive conclusions.

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