Background

The increasing number of primary Bariatric Surgeries (BaS), has led to a rise in the number of reoperations, which carry high perioperative complications. Comparison of Robotic and Laparoscopic approaches is fundamental to determine the best surgical option based on outcomes.

Methods

A retrospective analysis of the MBSAQIP data registry of patients undergoing reoperative BaS from 2015 to 2019 was done. Demographics, comorbidities, perioperative variables and surgical approach were collected. Outcomes for both approaches were major perioperative complications and mortality. Univariate analysis was performed to assess differences between the approaches. Multivariate logistic regression was used to adjust confounding variables and to evaluate the outcomes.

Results

A total of 126,490 revisions were identified; 93% (n=117,714) of the cases were Laparoscopic and 7%(n=8,776) Robotic. Majority of the patients were female (83.6%), with a mean age of 49.53 years. Univariate analysis revealed that Laparoscopic surgery is associated with a lower length of stay (LOS), 1.89±3.2 vs 2.22±3.25 days in robotic (p≤0.001). Major comorbidities were higher in robotic cases. Postoperative analysis showed higher readmission rates in the robotic group 8.2% (722) vs 5.31% (6,259) (p≤0.001). Operative time was longer in robotic cases (170.59±85.61 vs 104.73±69.62, p≤0.001). Multivariate analysis showed that the length of stay is significantly associated with the outcomes (OR= 0.930, CI: 0.920 – 0.941, p=0.001)

Conclusions

Robotic reoperative BaS seems to be associated with longer operative times, increased LOS, readmission rates and postop-complications. Our findings suggest that laparoscopic approach may be safer than robotic. Further studies are needed to asses these findings.