Background

Over the past several years, there has been an increasing number of robotic-assisted revisional bariatric surgeries (RBS). Outcomes, however, have been conflicting as regards advantage over conventional laparoscopy. In this study, we have examined the outcomes of RBS performed 'totally' robotic (TR) vs. laparoscopic (LAP).

Methods

The retrospective study included 143 RBS (84 TR, 59 LAP) performed by a single surgeon March 2019-Oct 2023. Most (93%) RBS were index surgery conversions to Roux-en-Y gastric bypass or duodenal switch; and, among these, 26% were band conversions and 74% conversions from a stapled procedure. Principal RBS indications were GERD, insufficient weight loss, and weight recurrence. Outcomes included: a) patient characteristics, b) operative times, 3) 30-day readmissions/reoperations/complications, d) length of stay (LOS), and e) lowest postoperative weight.

Results

Patient characteristics, operative times, and postoperative weight loss did not differ between TR-RBS and LAP-RBS. However, LOS was significantly (p=0.01) shorter for the TR vs. LAP procedures (1.31 days vs. 1.52 days). There were no conversions, leaks nor mortalities with either surgical approach. 30-day readmissions rates for the TR- and LAP-RBS averaged a respective 8.2% and 5.1%. For band conversions, surgical approach had no effect on operative time or complications but there was a TR trend toward lower LOS. For conversions from stapled procedures, the TR vs. LAP approach was associated with significantly (p=0.006) lower operative times (122.3 vs. 143.1 min) and shorter LOS (1.34 vs. 1.52 days).

Conclusions

TR-RBS is safe and associated with shorter LOS and, for stapled conversions, lower operative times.