There are similar overall early and late complication rates between primary and revisional robotically-assisted laparoscopic Roux-en-Y gastric bypass (RYGB), with higher rates of gastrojejunal strictures and readmissions for oral intolerance in the revisional group, according to a study by researchers from Texas. The results were reported in the paper, ‘Outcomes of primary versus revisional robotically assisted laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of ten-year experience’, published online in Surgical Endoscopy.
The researchers wanted to compare the outcomes between patients undergoing primary versus revisional robotically-assisted laparoscopic RYGB and carried out a retrospective analysis of a prospective database of 1,072 who underwent robotically assisted laparoscopic primary or revisional RYGB between 2009 and 2019 from two bariatric surgery centres in Texas. The revisional RYGB group included patients who underwent:
- Conversion from any other previous bariatric procedure to RYGB
- Revision of an existing RYGB
- RYGB performed for weight loss purposes in patients who had undergone previous anti-reflux procedures
All surgeons had performed at least 100 robotic general surgery procedures and 50 primary robotic RYGB and had a minimum of two years of bariatric experience beyond their fellowship training. The researchers subsequently classified robotic surgical experience as senior (more than 200) and junior (less than 200) robotic RYGB procedures. All surgeries were performed using the Si or Xi version of the da Vinci Surgical System (Intuitive Surgical).
Of the 1,072 patients, 806 underwent primary and 266 revisional robotically-assisted RYGB. Patients undergoing revisional RYGB were significantly older and had a lower BMI at time of surgery. Obesity-related comorbidities were more prevalent in the primary RYGB group, apart from GERD, which was more prevalent in the revisional group. There was a significantly longer mean follow-up for the revisional group (17.3 versus 16.6 months, p< 0.001). Of the 125 patients who had a conversion from adjustable gastric bands, 86 underwent a single-stage and 39 underwent a two-stage procedure.
The researchers found that there were no differences between groups in terms of early (<30 days) and overall postoperative complication rates, and early and overall severe (grade ≥ IIIa) complication rates were also similar between groups. Length of follow-up and surgical experience did not show different results. Patients in the revisional group had significantly higher rates of gastrojejunal stricture and oral intolerance requiring readmission. There was no difference between groups for other types of complication. The revisional group had a longer mean operative time (203 vs 154 min, p< 0.001). Rates of readmissions, intraoperative complications, conversions to laparotomy and mean length of hospital stay were similar between groups.
The researchers suggest that the relatively high number of overall postoperative complications is most likely due to the thorough tracking of all postoperative adverse events, even minor complications. The rates of severe complications and reoperations, were comparable to previously published studies.
“Despite the study being underpowered to detect a statistically significant difference between groups in specific complications such as gastrointestinal leak rates, these results suggest that the higher morbidity reported in the literature in patients undergoing laparoscopic revisional RYGB can potentially be decreased, if not brought down, to the low morbidity seen in primary procedures, when using the robotic approach,” the researchers concluded. “Further prospective studies are needed to confirm these results.”
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