Risk of gastrojejunal anastomotic stricture following hand-sewn robotic Roux-en-Y gastric bypass: a retrospective cohort study.

Gastrojejunal (GJ) stricture is one of the most common complications following Roux-en-Y gastric bypass with a hand-sewn anastomosis. This study aimed to evaluate the risk of GJ strictures in a series of robotic Roux-en-Y gastric bypasses (RRYGBP) performed by a single surgeon. This retrospective observational study included 314 consecutive patients with severe obesity who underwent RRYGBP with a 3-layer continuous hand-sewn GJ anastomosis using absorbable sutures between September 2017 and September 2024. All patients were followed up at 6-month intervals after the first month post-surgery. The mean age of the patients was 42.8 ± 11.3 years, and the mean pre-operative BMI was 41.3 ± 5.54 kg/m². The majority of patients were female 220 (70.1%), and 120 had obesity-associated comorbidities. A total of 68 (21.6%) revisional surgeries were performed. The average operative time (console time) was 150 ± 39.2 min, with the GJ anastomosis completed in an average of 15 min. Patients were discharged on the second postoperative day with a mean hospital stay of 3.13 ± 4.05 days. There were no complications related to the robotic platform. Early postoperative complications included 10 (3.1%) strictures, 3 (0.9%) leaks, and 4 (1.27% hemorrhage). Upper endoscopy was performed on postoperative day 1 in 5 (1.6%) cases for GJ dilation to allow gastroscope passage. There were no conversions to laparoscopy or laparotomy, and no mortality occurred. Anastomotic GJ stricture remains a common complication of laparoscopic Roux-en-Y gastric bypass for morbid obesity. The risk of stricture following RRYGBP is comparable, with important technical considerations that may help mitigate this complication.