OUTCOMES OF ROBOTIC-ASSISTED REVISIONAL BARIATRIC SURGERY
Steven M. Elzein*, Maria Corzo, Victor G. Peña, Sachin Shetty, Daniel Tomey, Rodolfo J. Oviedo
Houston Methodist Hospital, Houston, TX
Background:
Revisional bariatric surgery is becoming progressively more common in today's surgical landscape. It is one of the fastest-growing areas in bariatric surgery, exhibiting an estimated increase of more than 300% from 2017 to 2018. Although revisional bariatric procedures have classically been associated with higher morbidity and suboptimal outcomes compared to index bariatric operations, the emergence of increasingly-capable robotic-assisted surgery is a novel area of interest with regard to improving operative outcomes in the revisional bariatric population.
Methods:
Retrospective chart review analysis was carried out on twelve patients with prior bariatric procedures who subsequently underwent a robotic-assisted revisional bariatric surgery by a single surgeon at a large academic medical center. Data collection included patient demographics, BMI (kg/m2), medical comorbidities, intraoperative time, estimated blood loss, length of stay, postoperative complications, readmissions, and outcomes.
Results:
Out of twelve robotic-assisted bariatric surgical cases reviewed, seven involved Roux-en-Y gastric bypass (RNYGB) - four RNYGB revisions, one conversion from gastric sleeve to RNYGB, and two conversions from gastric band to RNYGB), while the other five consisted of gastrojejunal anastomotic (GJ) revisions. The average age of revisional patients was 44.3 years old and average BMI was 41.3 kg/m2. Hypertension, non-insulin-dependent diabetes mellitus, obstructive sleep apnea, and gastroesophageal reflux disease were among the most common medical comorbidities identified. Average case length was 3.14 hours with an average estimated blood loss of 39.2 mL. No complications were noted, including conversion to open surgery, blood-transfusion within thirty days of surgery, or re-operation. One out of twelve patients required readmission within one year of robotic revisional surgery for acute cholecystitis requiring cholecystectomy ten months after RNYGB revision.
Conclusions:
While revisional bariatric surgery has been associated with significant morbidity, the utilization of robotic surgical technology may help to improve outcomes in this patient population. We demonstrate that robotic-assisted revisional bariatric procedures can be safely and efficiently performed in this high-risk population. Further studies are necessary to elucidate the full spectrum of advantages of robotic-assistance in revisional bariatric surgery.
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