Robotic Assistance and Early Small Bowel Obstruction after Roux-en-Y Gastric Bypass: a Rare Event Analysis

Area of Science:

• Bariatric Surgery
• Minimally Invasive Surgery
• Surgical Technology

Background:

• Robotic assistance is increasingly used in gastric bypass surgery for enhanced visualization and precision.
• Certain anatomical factors, like the Brazilian technique, may increase the risk of early small bowel obstruction (eSBO).

Purpose of the Study:

• To evaluate the association between robotic assistance and the incidence of early small bowel obstruction (eSBO) after gastric bypass.
• To identify risk factors for eSBO in patients undergoing gastric bypass.

Main Methods:

• Retrospective cohort study utilizing the 2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.
• Analysis of 20,162 gastric bypass procedures, comparing outcomes between robotic and laparoscopic approaches.
• Rare-event logistic regression was used to assess the independent association of robotic assistance with eSBO, adjusting for covariates.

Main Results:

• The overall incidence of eSBO within 30 days was 1.74%, with a higher rate following robotic (2.11%) compared to laparoscopic (1.50%) procedures (p < 0.01).
• Robotic assistance was an independent predictor of eSBO (OR 1.24, 95% CI 1.00-1.55, p = 0.04).
• Patients with eSBO experienced high rates of readmission (74.57%) and reoperation (36.29%).

Conclusions:

• Robotic assistance is independently associated with an increased risk of early small bowel obstruction following gastric bypass.
• Technical aspects of the robotic approach may contribute to the elevated eSBO risk and warrant further investigation.