Background

Stomach intestinal pylorus-sparing surgery (SIPS) is an emerging procedure with unique technical challenges that may affect safe adoption and overall utilization.

Methods

Data on all SIPS cases was captured in a prospective manner from a single-center, two-surgeon community practice who adopted the procedure in 2021. (n=82) Patient and surgeon characteristics, operative details and 30-day complication rates are reported, and cumulative summation (CUSUM) analysis of operative time and case volume was performed.

Results

A total of 61 primary SIPS (pSIPS) and 21 sleeve gastrectomy to SIPS conversion (cSIPS) were performed between 3/10/2021 and 11/28/2022. All cases were performed robotically. Mean age for pSIPS and cSIPS cases was 40.0 years and 46.2 years, respectively, and mean body mass index (BMI) was 51.3 kg/m2 and 43.1 kg/m2. Mean length of stay was similar for both pSIPS and cSIPS (1.56 days and 1.38 days, respectively) and there were no complications in either group. Mean operative time at the console was 109 min for pSIPS and 80 min for cSIPS. Approximately 39 cases were required to achieve surgical proficiency for pSIPS and 9 cases for cSIPS. (Figure 1 and Figure 2). Surgeons had a combined total bariatric operative experience of 979 cases since 2015 (8.7% revisions). During the SIPS study period 88% of all bariatric cases were performed robotically.

Conclusions

SIPS can be performed safely in a community practice with appropriate patient selection and by bariatric surgeons with robotic experience. Conversion cases had a faster learning curve than primary cases.