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

Feb 9, 2018Obesity surgery

Surgery Results of Minimally Invasive and Robotic Weight-Loss Revisions in Complex Patients

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Abstract

Robotic revisional bariatric surgery (RRBS) is associated with a shorter average length of stay of 3.7 days compared to 5.8 days for laparoscopic revisional bariatric surgery (LRBS).

In a study of 84 patients, 18 underwent RRBS and 66 underwent LRBS.
No differences were found in operative time or complications when converting from adjustable gastric banding (AGB) between the two surgical approaches.
For patients converting from stapled procedures, RRBS resulted in a significantly shorter length of stay.
There were three leaks reported in the LRBS group, while no leaks occurred in the RRBS group.
Major complications occurred in 8% of patients converting from AGB and 4% from stapled procedures, with no significant difference by surgical approach.

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BACKGROUND: Utilization of the robotic platform has become more common in bariatric applications. We aim to show that robotic revisional bariatric surgery (RRBS) can be safely performed in a complex patient population with perioperative outcomes equivalent to laparoscopic revisional bariatric surgery (LRBS).

METHODS: Retrospective review was conducted of adult patients undergoing laparoscopic revisional bariatric surgery (LRBS) or robotic revisional bariatric surgery (RRBS) at our institution from September 2007 to December 2016. Patients undergoing planned two-stage bariatric procedures were excluded.

RESULTS: A total of 84 patients who underwent LRBS (n = 66) or RRBS (n = 18) were included. The index operation was adjustable gastric banding (AGB) in 39/84 (46%), sleeve gastrectomy (VSG) in 23/84 (27%), Roux-en-Y gastric bypass (RYGB) in 13/84 (16%), and vertical banded gastroplasty (VBG) in 9/84 (11%). For patients undergoing conversion from AGB (n = 39), there was no difference in operative time, length of stay, or complications by surgical approach. For patients undergoing conversion from a stapled procedure (n = 45), the robotic approach was associated with a shorter length of stay (5.8 ± 3.3 vs 3.7 ± 1.7 days, p = 0.04) with equivalent operative time and post-operative complications. There were three leaks in the LRBS group and none in the RRBS group (p = 0.36). Major complications occurred in 3/39 (8%) of patients undergoing conversion from AGB and 2/45 (4%) of patients undergoing conversion from a stapled procedure (p = 0.53) with no difference by surgical approach.

CONCLUSIONS: 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.

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

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