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

Gray, Katherine D.; Moore, Michal C.; Elmously, Adham; Bellorín, Omar; Zarnegar, Rasa; Dakin, Gregory; Pomp, Alfons; Afaneh, Cheguevara

doi:10.1007/s11695-018-3119-x

Cited by 58 publications

(33 citation statements)

References 26 publications

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“…Severe early complications after primary laparoscopic RYGB are relatively uncommon nowadays, with anastomotic leak rates ranging between 0.1 and 1.2% [8][9][10][11]. Higher morbidity and mortality have however been described after laparoscopic revisional RYGB, with anastomotic leak rates ranging from 4.5 to 11.8% [11][12][13][14][15][16][17][18][19].…”

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confidence: 99%

Outcomes of primary versus revisional robotically assisted laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of ten-year experience

et al. 2020

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Background Postoperative morbidity after laparoscopic bariatric surgery is considered higher for patients undergoing revisional versus primary procedures. The objective of this retrospective cohort study was to compare outcomes between patients undergoing primary versus revisional robotically assisted laparoscopic (RAL) Roux-en-Y gastric bypass (RYGB). Methods Data of all patients who underwent RAL primary and revisional RYGB between 2009 and 2019 at two accredited, high-volume bariatric surgery centers—the Memorial Hermann – Texas Medical Center, Houston, TX, and the Tower Health, Reading Hospital, Reading, PA, were analyzed. Primary outcomes were early (< 30 days) and overall postoperative complications. Secondary outcomes included intraoperative complications, operative times, conversions to laparotomy, length of hospital stay, early (< 30 days) postoperative readmissions and deaths. Results Data of 1072 patients were analyzed, including 806 primary and 266 revisional RAL RYGB procedures. Longer operative times (203 versus 154 min, P < 0.001), increased number of readmissions for oral intolerance (10.5% versus 6.7%, P = 0.046) and higher rate of gastrojejunal stricture (6.4% versus 2.7%, P = 0.013) were found in the revisional group. Gastrointestinal leak rates were 0.2% for the primary versus 1.1% for the revisional group (P = 0.101). Early (< 30 days) reoperations rates were 2.2% for the primary versus 1.1% for the revisional group (P = 0.318). There were no statistically significant differences between groups in overall and severe complication rates. Conclusion Patients undergoing RAL primary and revisional RYGB had comparable overall outcomes, with a non-significant higher early complication rate in the revisional group. Despite the study being underpowered to detect differences in specific complication rates, the morbidity seen in the revisional RYGB group remains markedly below literature reports of revisional laparoscopic RYGB and might suggest a benefit of robotic assistance. Further prospective studies are needed to confirm these results.

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Outcomes of primary versus revisional robotically assisted laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of ten-year experience

et al. 2020

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“…Regarding the LOS, results to date are contradictory. A reduction in the LOS was found in one study using the robot [27], while the registry data showed an extended LOS [28]. In the study by Clapp et al [28], the clear differences between cohorts regarding index operation and procedure must be mentioned.…”

Section: Prosmentioning

confidence: 94%

“…However, there was a significantly higher proportion of technical simple gastric band removals in the laparoscopic revision group, while consecutively the relative share of complex RYGB operations was higher in the robot group. One study reported a significant reduction in operative time in a subgroup of rRRYGB (193 min, da Vinci Xi) versus rLRYGB (238 min) [27]. We also used the Xi System.…”

Section: Prosmentioning

confidence: 99%

“…While primary bariatric interventions generally have a very low complication rate [20], advantages of the robotic system in revision interventions with higher complication rates may be more relevant. So far, there are several reports and case series with good results [21][22][23][24][25] but only a few comparative cohort studies [26,27]. A low complication rate has been reported, albeit with a low (n = 11) number of robotic interventions [26].…”

Section: Introductionmentioning

confidence: 99%

“…A low complication rate has been reported, albeit with a low (n = 11) number of robotic interventions [26]. Another group found a comparable safety profile of robotic interventions, while robotic revisional surgeries after stapled procedures were performed more quickly than laparoscopic ones [27]. Evaluation of registry databases showed no advantages when using the robot [28].…”

Section: Introductionmentioning

confidence: 99%

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Pros and Cons of Robotic Revisional Bariatric Surgery

Beckmann¹,

Mehdorn²,

Kersebaum³

et al. 2020

Visc Med

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Introduction: Revisional procedures in bariatric surgery are regarded as technically more demanding and riskier than primary interventions. While the use of the surgical robot has not yet proven to be advantageous in primary bariatric interventions, the question remains whether its use is justified for more complex revisional procedures. Objective: To show that revisional bariatric surgery can be performed safely using the da Vinci® Xi surgical system. Methods: We performed a retrospective analysis of prospectively recorded data for revisional bariatric procedures between January 2016 and November 2019. Results: Of 78 revision operations, four (5.1%) were performed by open surgery, 30 (38.5%) by laparoscopic surgery, and 44 (56.4%) by robotic surgery. A comparative analysis of robotic (n = 41) versus laparoscopic (n = 18) revisional Roux-en-Y gastric bypasses (rRYGB) revealed significant differences favoring the robotic approach for operative time (130.7 vs. 167.6 min), C-reactive protein values at days 1 (27.9 vs. 49.1 mg/L) and 2 (48.2 vs. 83.6 mg/L) after surgery, and length of stay (4.9 vs. 6.2 days). Lower complication rates (Clavien-Dindo II–V) were found after rRRYGB (7.3 vs. 22.2%, not significant). Conclusions: Revisional bariatric surgery using a robotic system is safe. The operative time performing rRRYGB is significantly shorter than rLRYGB in our experience. Otherwise, results were largely comparable. Due to different indications, different index operations and a wide range of revisional procedures, further studies are necessary to confirm these results.

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Revisional Robotic Bariatric Surgery

Domene

Volpe

2019

Bariatric Robotic Surgery

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

Abstract: RRBS is associated with a shorter length of stay than LRBS in complex procedures and has at least an equivalent safety profile. Long-term follow-up data is needed.

Cited by 58 publications

References 26 publications

Outcomes of primary versus revisional robotically assisted laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of ten-year experience

Outcomes of primary versus revisional robotically assisted laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of ten-year experience

Pros and Cons of Robotic Revisional Bariatric Surgery

Revisional Robotic Bariatric Surgery

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