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Comparative Outcomes of Robotic and Laparoscopic Conversion from Sleeve Gastrectomy to Roux-En-Y Gastric Bypass: An Analysis of MBSAQIP
Sara Saeidishahri
*1, Amir Ebadinejad
1, Devika Umashanker
2, Yin Wu
2, Darren Tishler
1, Dale Bond
2, Pavlos Papasavas
21Department of Surgery, Hartford Hospital, Hartford, CT; 2Center for Obesity Research, Innovation, and Education, Digestive Health Institute, Hartford HealthCare,, Hartford, CT
Background: The optimal approach for converting sleeve gastrectomy to Roux-en-Y gastric bypass remains unclear, as previous studies have reported mixed results on only selective complications and no studies have conducted a comprehensive assessment of perioperative outcomes. This study addresses this gap by comparing laparoscopic (LC-RYGB) and robotic (RC-RYGB) conversion from sleeve gastrectomy to Roux-en-Y gastric bypass, incorporating the Comprehensive Complication Index (CCI).
Study Design: A retrospective analysis of the MBSAQIP database (2020–2023) was conducted to compare patients who underwent LC-RYGB versus RC-RYGB. Primary outcomes included CCI and serious adverse events (SAE), defined as CCI ?26.2. Univariate and multivariate analyses assessed the association between surgical approach and perioperative outcomes.
Results: A total of 37,903 patients were included (LC-RYGB: 25,328 [66%]; RC-RYGB: 12,575 [33%]). RC-RYGB had a longer operative time (162.95 ± 66.95 vs. 134.64 ± 64.18 min, p = 0.001) but a shorter length of stay (1.63 vs. 1.68 days, p = 0.018). The CCI was comparable between groups (3.82 ± 11.21 [RC-RYGB] vs. 3.84 ± 11.32 [LC-RYGB], p = 0.64) with no significant difference in SAE rates (5.5% vs. 5.5%, p = 0.76), ED visits (12.9% vs. 12.7%, p = 0.66) and mortality (0.1% vs. 0.1%, p = 0.33). Surgical approach was not a significant predictor of SAE (OR=0.97, 95%CI: 0.88-1.06, p = 0.53), ED visits (OR=1.01, 95% CI:0.95-1.08, p = 0.68), or mortality (OR=0.74, 95% CI:0.4-1.38, p = 0.33).
Conclusion: Despite longer operative time in RC-RYGB, both techniques demonstrated comparable outcomes in complication rates, SAE, ED visits, and mortality. Further research, is warranted to determine cost-effectiveness and long-term benefits.
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