Impact of Robotic Assistance on Complications in Bariatric Surgery at Expert Laparoscopic Surgery Centers: A Retrospective Comparative Study With Propensity Score.

OBJECTIVE: To investigate the way robotic assistance affected rate of complications in bariatric surgery at expert robotic and laparoscopic surgery facilities. BACKGROUND: While the benefits of robotic assistance were established at the beginning of surgical training, there is limited data on the robot's influence on experienced bariatric laparoscopic surgeons. METHODS: We conducted a retrospective study using the BRO clinical database (2008-2022) collecting data of patients operated on in expert centers. We compared the serious complication rate (defined as a Clavien score≥3) in patients undergoing metabolic bariatric surgery with or without robotic assistance. We used a directed acyclic graph to identify the variables adjustment set used in a multivariable linear regression, and a propensity score matching to calculate the average treatment effect (ATE) of robotic assistance. RESULTS: The study included 35,043 patients [24,428 sleeve gastrectomy (SG); 10,452 Roux-en-Y gastric bypass (RYGB); 163 single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S)], with 938 operated on with robotic assistance (801 SG; 134 RYGB; 3 SADI-S), among 142 centers. Overall, we found no benefit of robotic assistance regarding the risk of complications (average treatment effect=-0.05, P =0.794), with no difference in the RYGB+SADI group ( P =0.322) but a negative trend in the SG group (more complications, P =0.060). Length of hospital stay was decreased in the robot group (3.7±11.1 vs 4.0±9.0 days, P <0.001). CONCLUSIONS: Robotic assistance reduced the length of stay but did not statistically significantly reduce postoperative complications (Clavien score≥3) following either GBP or SG. A tendency toward an elevated risk of complications following SG requires more supporting studies.

Benefits and risks of bariatric surgery in patients aged more than 60 years.

BACKGROUND: The benefits and risks of bariatric surgery are debated in older patients. The objective of this study was to compare the weight changes and adverse outcomes in patients>60 years and in younger ones. METHODS: The French SOFFCO registry was screened for gastric bypass (RYGB), gastric banding (LAGB), or sleeve gastrectomy (SG) performed between 2007 and 2010. Adverse outcomes and weight changes (%) over 12 months were compared between patients<40 years (N = 1379), between 40-59 years (N = 1065), and>60 years (N = 164). RESULTS: After a RYGB surgical (12.3 versus 3.8%; P = .03) and nonsurgical (7.0% versus .8%; P = .01) complications were more prevalent in patients above 60 years than in those below 40. No increased prevalence of surgical and nonsurgical complications was seen after a LAGB or a SG. Weight loss (% of initial weight) was lower after a LAGB than after a RYGB or a SG. After LAGB weight loss (%) did not differ between patients above 60 years and those aged<40 (difference 1.7±1.5%, P = .26). After a RYGB weight loss (%) was lower in patients aged>60 years (-5.6±1.7%, P = .001) than in those aged<40 years. After a SG, weight loss (%) was lower in patients aged>60 years (-7.0±2.6%, P = .01) than in those aged<40 years. CONCLUSION: Bariatric surgery can be a short-term effective and safe therapeutic option in elderly patients. LAGB or SG appears to be an alternative strategy to RYGB, with lower adverse outcome rate.

Intragastric balloon for "non-morbid" obesity: a retrospective evaluation of tolerance and efficacy.

BACKGROUND: One potential indication for intra-gastric balloon is weight reduction for mild to moderate obesity. The authors evaluated retrospectively the tolerance and efficacy of the BioEnterics intragastric balloon (BIB). METHODS: From February 1998 to July 2001, an intragastric balloon was placed under endoscopic control in 176 patients (mean BMI 31 kg/m(2)). It was filled with 500 ml saline in the first 142 patients and with 600 ml in the last 34. Removal was proposed between 4 and 6 months after balloon insertion. RESULTS: Balloon placement was uneventful. 13 patients were lost of follow-up (7.4%). Removal was performed endoscopically in 113 patients (64.2%), with 1 case of tracheal aspiration. Balloon evacuation was spontaneous in 49 cases. 1 BIB was removed at laparoscopic surgery for small bowel obstruction. Side-effects were: vomiting during the first week (90%), occasional vomiting for >3 weeks (18%), hypokalemia (8.5%), functional renal failure (1.1%), abdominal pain (12.5%), gastro-esophageal reflux (11.5%). There were 2 gastric ulcers, 1 sub-occlusion treated endoscopically and the 1 small bowel obstruction treated surgically, occurring after the theoretical date of removal in all cases. Mean excess weight loss was 38 +/- 28.5 % (35.4 +/- 27.3 % for 500-ml balloons and 48.8 +/- 31.0 % for 600-ml balloons (P <0.02)). CONCLUSIONS: The BIB appears to be safe provided that it is removed within the period specified by the manufacturer. Its efficacy to reduce weight in patients with non-morbid obesity may depend in part on the filling volume.

[Retrograde extraperitoneal laparoscopic prostatectomy (R.E.I.P). Simplified technique (based on a series of 143 cases]. / Prostatectomie extrapéritonéale rétrograde laparoscopique (P.E.R.L.) Technique simplifiée (à propos d'une série de 143 cas).

Since the first laparoscopic prostatectomies, performed via an intraperitoneal approach in Bordeaux, France, in November 1997 (Gaston et al.) and then via an extraperitoneal approach in Belgium in September 1999 (BOLLENS et al.), several French (Montsouris and Mondor) and European teams have adopted and amplified these approaches, but much late and more discreetly in the case of the extraperitoneal approach. A multidisciplinary collaboration initiated in Lyon in 1999 has led to the development of an original retrograde extraperitoneal laparoscopic technique (R.E.L.P.) which exactly reproduces the conventional open operation and which allows primary access and dissection of the erectile neurovascular pedicles and the prostatic-urethral sphincter junction, followed by retrograde prostato-rectal dissection. This technique, based on a series of 143 operations at the end of 2002, which exclusively uses an oblique vision scope, comprises the following steps: 1. Access to and exposure of the surgical field, an essential step which determines the success of the rest of the operation. 2. Primary or secondary pelvic lymphadenectomy. 3. Primary access to the erectile neurovascular pedicles and prostatic-urethral sphincter junction, which, together with the following step, represents the original feature of this technique. 4. Urethral section and retrograde prostato-rectal and seminal dissection. 5. Vesico-prostatic cleavage, and antegrade dissection of the seminal vesicles and vesico-prostatic attachments. 6. Vesicourethral anastomosis by interrupted sutures tied extracorporeally. The still limited preliminary results are very encouraging and will soon be reviewed with a longer follow-up, which should show that the retrograde extraperitoneal approach is a technique of choice for laparoscopic radical prostatectomy.