Berks County Medical Society Medical Record Fall 2018 - 19

mer Research Projects
Robotic-assisted versus Laparoscopic Gastric Bypass Surgery:
A Multicenter Analysis
by David Talarico, John Fam, Stephan Myers, Eric Wilson
INTRODUCTION:
The gastric bypass surgery was first performed by Dr. Mason and
Dr. Ito in 1967 and has since accounted for over 350,000 bariatric
surgeries between 2011 and 2017. With better outcomes and
similar efficacy to open gastric bypass, the laparoscopic procedure
has become the standard for this surgery, but the da Vinci Surgical
System shows promise to further decrease complications while
maintaining efficacy for gastric bypass patients. This study was
conducted by a multi-center team led by the University of Texas to
compare the short-term clinical outcomes of robotic-assisted and
laparoscopic elective bariatric surgery with a focus on gastric bypass.

METHODS:
A retrospective chart review at multiple institutions was
conducted and expected to enroll at least 2,078 patients who
underwent robotic-assisted and laparoscopic elective bariatric
surgery. At Reading Hospital, the review included patients over
18 years of age who underwent robotically-assisted primary gastric
bypass surgery or robotically-assisted conversion to gastric bypass
surgery between April 2012 and December 2017. Patients' charts
were accessed electronically to collect data on demographics,
patient characteristics, pre-operative history, intra-operative data,
post-operative data up to 30 days, and follow-up data up to 1-year
post-op. Means, standard deviations, and confidence intervals
were determined for the data with missing values excluded. The
results from the robotic-assisted cohort will be compared to the
laparoscopic cohort from other institutions using a Student's t-test
for continuous variables and a Chi-squared test for discrete variables
with a p-value of less than 0.05 being considered statistically
significant.

RESULTS:
There were a total of 370 eligible candidates for the study cohort
from Reading Hospital with 79 males and 291 females. Patients
ranged from 19 to 74 years of age with an average of 44.19 years
of age. They had an average BMI of 42.90 kg/m2 at operation and
lost an average of 71.19 ± 2.3% of excess weight after 1 year (95%
CI). According to Clavien-Dindo Classifications, the cohort had a
4.054% rate of major complications within 30 days post-op and a
11.081% rate of major complications prior to 1-year post-op. They
also had a 2.162% rate of strictures and a 1.081% rate of leaks.
Mortality within 30 days was 0.2703% (1 patient). Of the 370

patients, there were a total of 29 revisions. Revision patients had a
0% rate of major complications within 30 days post-op and a
3.448% rate of major complications prior to 1-year post-op. They
also had a 3.448% rate of strictures and a 0% rate of leaks.

CONCLUSIONS:
The results of the study show similar efficacy with decreased
rates of complication compared to previous conventional
laparoscopic studies. In comparison to several other studies, the
excess weight loss after one year was within the 65-75% standard.
The major complication rates were comparable or slightly lower
overall compared to prior data on conventional laparoscopic
leaks rates (1-5%) and stricture rates (5-17%). For revisions,
the improvement was more substantial with previous major
complication rates of 10-40% -. The maintained effectiveness and
decreased complication rates supports the superiority of roboticassisted gastric bypass surgery over conventional laparoscopic
surgery especially for revisions.
Myers, S. R. (2017) Type 2 Diabetes: New Doorways to Health. Maitland, FL:
Mill City Press.
Estimate of Bariatric Surgery Numbers, 2011-2017. (2018).
In ASMBS. Retrieved July 9, 2018, from https://asmbs.org/resources/estimateof-bariatric-surgery-numbers
Schauer, P. R., Ikramuddin, S., Gourash, W., Ramanathan, R.,
& Luketich, J. (2000). Outcomes After Laparoscopic Roux-en-Y Gastric Bypass
for Morbid Obesity. Annals of Surgery, 232(4), 515-529.
Lee S, Carmody B, Wolfe L, et al. Effect of location and speed of diagnosis on
anastomotic leak outcomes in 3828 gastric bypass cases.
J Gastrointest Surg 2007;11:708-13.
Nguyen NT, Stevens CM, Wolfe BM. Incidence and outcome of anastomotic
stricture after laparoscopic gastric bypass. J Gastrointest Surg 2007;7:9971003.
Roller, J.E. & Provost, D.A. Revision of Failed Gastric Restrictive Operations
to Roux-en-Y Gastric Bypass: Impact of Multiple Prior Bariatric Operations on
Outcome. Obes Surg (2006) 16: 865.
Shimizu, H., Annaberdyev, S., Motamarry, I. et al. Revisional Bariatric
Surgery for Unsuccessful Weight Loss and Complications.
Obes Surg (2013) 23: 1766.

David Talarico is a senior Biology major at
DeSales University in Center Valley, PA.
FALL 2018

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Berks County Medical Society Medical Record Fall 2018

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