The research article titled “Gastric bypass performed with different surgical platforms during different periods” investigates the gastric bypass with different surgical platforms, comparing robotic gastric bypass (RGB) and laparoscopic gastric bypass (LGB) using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) databases. The study spans cases performed from 2015 to 2021 and aims to clarify the impact of increasing robotic surgery utilization on patient-reported outcomes.

Study Design and Methodology

This matched retrospective cohort analysis included a total of 286,531 Roux-en-Y gastric bypass (RYGB) cases, with 87% performed laparoscopically and 13% robotically. The researchers conducted a 1:1 matched analysis that compared outcomes between gastric bypass performed with different surgical platforms (LGB vs RGB) across two different time periods: 2015–2018 and 2019–2021. The study assessed various postoperative outcomes, including mortality, surgical site infection (SSI), bleeding, readmission, reoperation, and overall morbidity.

Key Findings

1. Overall Cohort Outcomes:
   • Mortality was low in both cohorts at 0.1%, with no significant difference between LGB and RGB.
   • The incidence of SSI was lower in the RGB cohort (0.9%) compared to LGB (1.3%), and bleeding rates were also lower for RGB (0.3% vs. 0.4%).
   • Conversely, the RGB cohort exhibited higher rates of readmission (5.8% vs. 4.9%), reoperation (2.2% vs. 1.85%), and overall morbidity (7.6% vs. 6.8%).
   • Operative length was significantly longer for RGB at 150.34 minutes compared to 117.97 minutes for LGB.
2. Trends Over Time:
   • In both the early (2015-2018) and later (2019-2021) cohorts, RGB consistently showed lower rates of SSI and bleeding.
   • However, the operative duration remained longer for RGB. In the later cohort, while SSI and bleeding rates remained lower with RGB, the overall morbidity was higher.
3. Statistical Analysis:
   • Conditional fixed-effects logistic regression revealed that while RGB had significantly lower odds of SSI (OR 0.68) and bleeding (OR 0.74), it also had higher odds for readmission (OR 1.19), reoperation (OR 1.20), and overall morbidity (OR 1.12). The operative length for RGB was significantly longer by an average of 32.37 minutes.

Discussion

The study highlights the growing adoption of robotic-assisted surgery in gastric bypass procedures. It concludes that while both surgical platforms demonstrate low mortality and morbidity, RGB may offer benefits in terms of reduced SSI and bleeding rates. However, this comes at the cost of increased readmission, reoperation rates, and longer operative times. The findings indicate an overall trend of improving postoperative outcomes over time, suggesting that as robotic surgery becomes more prevalent, its associated risks and benefits continue to evolve.

Limitations

The authors acknowledge several limitations inherent in their study, including the retrospective nature of the analysis, potential data incompleteness, and the lack of granularity regarding surgical techniques and surgeon experience. These factors may influence the outcomes observed and limit the ability to draw definitive conclusions.

Conclusion

In summary, this study provides valuable insights into the comparative outcomes robotic vs laparoscopic gastric bypass. It underscores the importance of continued evaluation of surgical techniques as robotic surgery becomes more widely adopted. The research suggests that while RGB may reduce certain complications, it may simultaneously increase others, necessitating ongoing analysis to optimize patient care in bariatric surgery.

READ MORE… https://link.springer.com/article/10.1007/s11701-025-02232-5

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