Robotic Roux-en-Y Gastric Bypass as a Revisional Bariatric Procedure: a Single-Center Prospective Cohort Study.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is the procedure of choice to manage the failure of primary bariatric surgery. However, the current evidence on the role of the robotic technology in revisional bariatric surgery is very limited. The aim of this study is to report safety and effectiveness of revisional RYGB performed with the DaVinci Robotic Surgical System (R-rRYGB) after failed primary bariatric surgery. METHODS: Clinical data of consecutive patients undergoing R-rRYGB were included in a prospectively collected database. Intraoperative findings, early postoperative outcomes, and 1-year follow-up results were considered. Primary outcome was postoperative morbidity rate. Secondary outcomes were conversion to open surgery, length of stay, percentage of excess weight loss (%EWL), resolution of complications, and costs. RESULTS: A total of 68 patients underwent R-rRYGB at our department from 2011 to 2016. Primary procedures were laparoscopic adjustable gastric banding (n = 10), vertical banded gastroplasty (n = 43), and sleeve gastrectomy (n = 15). Conversion rate to open surgery was 2.9%. Postoperative morbidity rate was 8.8%, with no anastomotic leaks reported. Total cost for surgical procedure was 14,334.7 ± 2920.4 €. CONCLUSIONS: Revisional RYGB is a complex procedure but can be performed with the robotic approach with a low morbidity rate. Weight loss outcomes and resolution of complications of the index procedure are satisfactory.