Background

Robotic revisional bariatric surgery has become increasingly popular across MBSAQIP centers. Our study aims to evaluate those trends and compare 30-day outcomes between robotic and laparoscopic SG to RYGB conversions.

Methods

To assess trends, the conversion/revision MBSAQIP variable was utilized to track case volume over the last 7 years. The 2020-2021 MBSAQIP database was then analyzed using the variable “conversion”. Patients with robotic and laparoscopic conversion of SG to RYGB were identified. The cohorts were matched for 16 preoperative characteristics using propensity score matching analysis. Then, 30-day outcomes and bariatric-specific complications between robotic and laparoscopic SG to RYGB conversions were compared.

Results

Robotic secondary bariatric surgery increased from 8% in 2015 to 24% in 2021 (Figure 1). There were 1,871 and 6,842 cases of robotic and laparoscopic SG to RYGB conversions, respectively. Propensity-matched cohorts were 1,870 and the outcomes indicated that patients who underwent robotic SG to RYGB had significantly fewer unplanned ICU admissions (0.5% vs. 1.2%, p=0.019) and blood transfusions (1.1% vs. 1.9%, p=0.045) compared to the laparoscopic approach. The robotic approach had longer operative times (175.73 + 71.80 min vs. 140.07 + 68.73, p=0.013) and greater stricture formation (0.6% vs. 0.3%, p=0.031).

Conclusions

A robotic approach to secondary bariatric surgery has tripled in the past seven years. Robotic conversion of SG to RYGB can be performed safely with similar 30-day outcomes compared to a laparoscopic approach. While the robotic approach may take longer, there may be benefits observed in fewer unplanned ICU admissions and bleeding complications.