Background

SG is the most performed procedure in bariatric surgery. Patients may experience GERD and weight regain, necessitating conversion to RYGB. This study aims to evaluate leak rates after conversion from SG to RYGB (robotic vs. laparoscopic).

Methods

Retrospective study of SG to RYGB conversions in the MBSAQIP database (2017-2021). Logistic regression were performed to identify factors associated with leaks.

Results

13,441 patients underwent SG to RYGB conversions. 90.5% were female, 62% were white, and 27% were black. The most common indication for conversion was GERD (52%), then weight gain (46%). The robot was utilized in 23.3% of cases. 57 patients developed an anastomotic leak, 15.8% in the robotic group vs. 84.2% in the laparoscopic group (p <0.01). Operative time between the two groups were the same. Within 30 days, 23 patients required an intervention (OR 2.17), and 42 patients had re-operation (OR 2.33), although not statiscally significant. There were three mortalities in the leak group. Previous surgery had a significant correlation with faster leak onset (p= 0.05). Patients with pre-operative pulmonary risk factors had a faster leak onset (delta 6 days; p = 0.004) and were more likely to be readmitted under 20 days (p <0.01). Factors associated with higher leak odds were a history of DVT/PE, renal insufficiency, and asian/pacific islander races (p < 0.05). No association with leaks were found with diabetes, smoking, or prior surgery.

Conclusions

Compared to laparoscopy, Robotic SG to RYGB conversions demonstrated lower leak rates, with no significant difference in operative times.