Comparative analysis of robotic versus laparoscopic revisional bariatric surgery outcomes from the MBSAQIP database
Nasser H, Munie S, Kindel T, Gould J, and Higgins R. Comparative analysis of robotic versus laparoscopic revisional bariatric surgery outcomes from the MBSAQIP database. Surg Obes Relat Dis 2019; 15(10):S80-S81.
Surg Obes Relat Dis
Background: There is limited data evaluating the role of robotics in revisional bariatric surgery compared to laparoscopy. The purpose of this study was to compare outcomes of laparoscopic and robotic revisional bariatric surgery using the MBSAQIP database. Methods: The 2015-2017 MBSAQIP database was queried for patients undergoing revisional robotic and laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Multivariate logistic regression was used to compare outcomes between robotic and laparoscopic approaches, adjusting for co-morbidities and operative time. Results: A total of 17,022 patients underwent revisional SG with 15,938 (93.6%) laparoscopic and 1,084 (6.4%) robotic, and 12,451 patients underwent revisional RYGB with 11,213 (90.1%) laparoscopic and 1,238 (9.9%) robotic. There was no difference in overall morbidity between robotic and laparoscopic SG (4.52% vs. 3.22%; AOR 1.12; p=0.48). However, there were higher organ space surgical site infections (SSIs), sepsis, and reinterventions with robotic SG. Robotic RYGB was associated with lower overall morbidity compared to laparoscopic (5.25% vs. 7.96%; AOR 0.62; p<0.01) as well as lower respiratory complications, pneumonia, superficial SSIs, and postoperative bleeding. The robotic approach with both procedures was associated with longer operative time (p<0.01). Length of stay was longer in the robotic group for SG (p<0.01) but was not different for RYGB (p=0.87). Conclusions: Robotic revisional bariatric surgery has a similar overall complication profile compared to the laparoscopic approach for sleeve gastrectomy and decreased for Roux-en-Y gastric bypass. Further analysis is needed regarding variability in surgeon technique and operative experience to determine what factors contribute to these differences. [Figure presented]