Comparison of Perioperative Outcomes Between Conventional Laparoscopic Approach and Robot-Assisted Approach in Revision and Conversion Surgery: Experience at the National Medical Center "20 de Noviembre".

Introduction Revision and conversion surgery (RCS) is technically demanding and associated with higher perioperative risk compared with primary bariatric procedures. The increasing adoption of robotic technology has expanded surgical options for complex revisional cases; however, comparative data from public healthcare institutions remain limited. This study aimed to compare perioperative outcomes between conventional laparoscopic and robot-assisted laparoscopic approaches (RALA) in patients undergoing RCS at a tertiary referral public center. Methods An observational, analytical, retrospective comparative study was conducted at the National Medical Center "20 de Noviembre," Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, including patients who underwent bariatric revisional surgery between January 2021 and December 2024 using either a conventional laparoscopic or RALA. Perioperative outcomes were compared between groups. Continuous variables were analyzed using Student's t-test or the Mann-Whitney U test, and categorical variables using the chi-square test, with statistical significance set at p < 0.05. Results A total of 90 patients underwent bariatric revisional surgery. The RALA was associated with significantly longer operative time than conventional laparoscopy (193.1 ± 25 vs 145.6 ± 18 minutes, p < 0.0001). Overall complication rates were low (3.3%), with no significant differences between groups, and no mortality was observed. Conversion rates were comparable between approaches. Conclusion In a high-volume public referral center, both conventional laparoscopic and robot-assisted RCS demonstrated favorable perioperative outcomes. Although operative time was significantly longer with the RALA, complication rates were comparable, with no mortality reported. These findings suggest that robot-assisted RCS may be a feasible approach in specialized centers; however, further prospective studies with larger cohorts and longer follow-up are needed to better define the comparative role of robotic and conventional laparoscopic approaches.