Comparative analysis of robotic versus laparoscopic revisional bariatric surgery: perioperative outcomes from the MBSAQIP database

Background: There are limited data evaluating the role of robotics in revisional bariatric surgery (RBS) compared with laparoscopy. Objective: The purpose of this study was to compare perioperative outcomes of laparoscopic and robotic RBS. Setting: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Methods: The 2015 to 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 demographic characteristics, co-morbidities, and operative time. Results: A total of 17,012 patients underwent revisional SG with 15,935 (93.7%) laparoscopic and 1077 (6.3%) robotic, and 12,442 patients underwent revisional RYGB with 11,212 (90.1%) laparoscopic and 1230 (9.9%) robotic. Overall morbidity was higher in robotic SG compared with laparoscopic SG (6.7% versus 4.5%; adjusted odds ratio 1.51; P < .01) which was not the case after adjustment for operative time. Robotic RYGB was associated with comparable overall morbidity to laparoscopic (9.3% versus 11.6%; adjusted odds ratio.83; P = .07) although respiratory complications, pneumonia, superficial surgical site infections, and postoperative bleeding were lower with robotic RYGB. The robotic approach with both procedures was associated with longer operative time (P < .01). Length of stay was longer in the robotic group for SG (P < .01) but was not different for RYGB (P = .91). Conclusions: Robotic RBS has an increased complication profile compared with the laparoscopic approach for SG and decreased for RYGB. Further analysis is needed regarding variability in surgeon technique and operative experience to determine what factors contribute to these differences. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.