Patricio Cal, MD, Luciano Deluca, MD, Tomas Jakob, MD, Gonzalo Crosbie, MD, Ezequiel Fernandez, MD. Hospital Churruca
Introduction: Single anastomosis gastric bypass (SAGB) has become a commonly performed primary bariatric surgery. Laparoscopic has been the preferred approach, and reports on robotic SAGB are scarce.
Our goal was to assess the feasibility and safety of totally robotic SAGB and compare it to the laparoscopic technique.
Methods & Procedures: From January 2016 to September 2017 all SAGB performed were compared. Laparoscopic or robotic approach were chosen on a schedule availability basis. Data was collected prospectively and it involved anthropometric data, presence of type 2 diabetes mellitus (T2DM), % of preoperative total weight loss (%PTWL), surgical time, postoperative length of stay, 30-day complications, and need for readmission or reoperation.
Comparison between groups was carried on with t-test for continuous data and with Chi-square test for dichotomous variables. A P lower than 0.05 was considered significant.
Results: Overall 131 SAGB were performed, 111 laparoscopic and 20 robotic. A long and thin gastric pouch was created calibrated by a 27 Fr Bougie and a 2.5 cm antecolic antegastric gastro-jejunal (GJ) anastomosis was performed 200-250 cm distal to the ligament of Treitz, using a linear stapler for the laparoscopic and totally manual for robotic patients.
Groups (laparoscopic vs robotic) were comparable regarding age (46 vs 45.3 years, P=0.77), BMI (48.1 vs 47 kg/m2, P=0.53), %PTWL (13.6 vs 16.9 %, P=0.29) and % with T2DM (51 vs 35%, P=0.2). There were fewer men in the laparoscopic group (20.2 vs 45%, P=0.015).
Surgical length was significantly higher for the robotic group (145±30.6 min) compared to laparoscopic (63.5±11.9 min, P<0.0001). Comparing the first 5 and the last 5 robotic surgeries, the last 5 were significantly shorter (107 vs 168 min). There were no conversions. Length of stay was 1.05 days in each group.
There were 6 (5.4%) major complications in the laparoscopic group: 3 bleedings from the GJ anastomosis, one of which required reoperation, 1 severe dumping syndrome, 1 GERD requiring revision and 1 GJ stricture that underwent relaparoscopy. The only complication (5%) in the robotic group was an acute pancreatitis.
Readmission rate was 5% in both groups and reoperation rate was 3% for laparoscopic and 0% for robotic surgeries.
Conclusions: Totally robotic SAGB with manual gastro jejunal anastomosis was safe and feasible in this early experience compared to laparoscopic approach. Surgeries took longer in the robotic assisted group, although a shorter time was achieved with training.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87258
Program Number: P820
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster