Roux-en-Y gastric bypass: impact of surgical approach on short-term postoperative complications

To compare 30-day postoperative complications after Roux-en-Y gastric bypass performed using a robot-assisted approach (RRYGB) versus a laparoscopic approach (LRYGB).

We conducted a retrospective single-center study including adult patients undergoing primary RYGB between February 2021 and November 2024. Early postoperative complications (≤ 30 days) were analyzed in the entire cohort and compared between surgical approaches, with propensity-score matching performed to reduce confounding. Complications occurring beyond 30 days were analyzed descriptively up to 1 year postoperatively, without matching, due to heterogeneous follow-up.

Among the 406 patients included (27.1% LRYGB, 72.9% RRYGB), 15.3% experienced at least one 30-day postoperative complication, with no significant difference between groups (LRYGB: 20.1% vs. RRYGB: 13.2%, p = 0.09). After matching, this difference remained non-significant (20.2% vs. 13.8%, p = 0.279). The severity of complications according to the Clavien-Dindo classification was comparable between groups. However, the reoperation rate was significantly higher in the LRYGB group (8.2% vs. 1.7%, p = 0.004). Operative time was shorter for laparoscopy (74.2 min vs. 83.5 min, p < 0.001). No significant difference was observed regarding complications beyond 30 days.

In this high-volume bariatric center, robotic and laparoscopic RYGB demonstrated comparable short- and mid-term safety profiles. The robotic approach was not associated with increased early or late morbidity and was associated with a lower rate of early surgical reinterventions. These findings support robotic RYGB as a safe and reliable alternative to laparoscopy in experienced centers. Further studies with standardized long-term follow-up are needed to better define potential long-term benefits of robotic assistance.