Volume 2 ; Issue 1 ; in Month : Jan-Jun (2018) Article No : 111
Alharthi S, Adair M, Das C

Abstract

Background: Gastric bypass is most commonly performed via the laparoscopic approach. However, some believe that the robotic approach could overcome limitations of laparoscopic surgery. In this study we seek to compare the outcomes of robotic and laparoscopic approaches to gastric bypass. Methods: We analyzed data of patients who underwent gastric bypass surgery using the National Inpatient Sample database between 2008-2013. Utilization and outcome measures including demographics, primary expected payer, in-hospital mortality, pre-existing comorbidities, complications, length of hospital stay, and total hospital charge were compared between the two different surgical approaches. These parameters were analyzed by chi-square, non-parametric tests and multivariate linear regression. Results: The six-year number of patients who underwent elective Roux-en-Y gastric bypass procedures in the United States from 2008 to 2013 is estimated to be 395,954. Of these, 97.9% were conducted via the laparoscopic approach, while 2.1% were conducted via the robot-assisted approach. The mean ages at the time of procedure were 44.82 ± 11.9 and 46.19 ± 12.2 in laparoscopic and robotic approaches, respectively (p<0.001). Females represented most of the patients (79% and 76.5% in laparoscopic and robotic groups, respectively, p=0.013). No significant differences existed between the two groups when compared in respect to race, diabetes mellitus, hypertension, ischemic heart disease, chronic kidney disease, and chronic obstructive pulmonary disease (COPD). Postoperative complications were comparable between groups with respect to pulmonary embolism, deep venous thrombosis, pain, bleeding, bowel obstruction, paralytic ileus, abscess, atelectasis, adhesion, and anastomotic leak. The overall mortality was similar between both the laparoscopic and robot-assisted groups (0.1% vs. 0.2%, respectively, p=0.44). Length of hospital stay was statistically significantly longer in the robotic approach (mean 2.7 days vs. 2.4 days, p<0.001). Patients who underwent robotic surgery had significantly higher total hospital charges compared to patients who underwent laparoscopic surgery (median $56,114 vs. $39,765 USD, p<0.001). Conclusions: Most gastric bypass procedures are done via the laparoscopic approach. The robotic technique has no clinical advantages in relation to morbidity and mortality. Additionally, the robotic procedure has significantly higher total charges.

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