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

BACKGROUND

Robotics has gained increasing adoption for roux-en-y gastric bypass, offering improved visualization and precision. However, unique anatomic configurations, such as the "Brazilian technique," may predispose to early small bowel obstruction (eSBO).

METHODS

We performed a retrospective cohort study using the 2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database to evaluate adults undergoing gastric bypass. The primary exposure was robotic assistance. eSBO within 30 days was identified from main and ancillary files. Associations were analyzed using rare-event logistic regression, adjusting for demographic, comorbid, and procedural covariates.

RESULTS

Among 20,162 roux-en-y gastric bypasses (38.4% robotic), eSBO occurred in 1.74% overall, with higher incidence after robotic versus laparoscopic procedures (2.11% vs. 1.50%, p < 0.01). Robotic assistance independently predicted eSBO (OR 1.24, 95% CI 1.00-1.55, p = 0.04). The association remained consistent in patients with and without prior foregut surgery, primary, revision and conversion procedures. Overall, gastric bypass patients with eSBO experienced a readmission rate of 74.57%, reoperation rate of 36.29%, and needing other interventions in 22.86%.

CONCLUSIONS

Robotic assistance independently increases the risk of eSBO following roux-en-y gastric bypass. Technical differences inherent to the robotic approach may contribute and warrant further investigation.