Indications and Outcomes of Laparoscopic Versus Robotic Conversional Bariatric Surgery: An MBSAQIP Study

Abstract

BACKGROUND: Conversional bariatric surgeries (CBS) are performed using laparoscopic and robotic techniques, but comprehensive data comparing these approaches remains scarce. OBJECTIVE: To compare the indications and outcomes of laparoscopic versus robotic CBS. METHODS: The MBSAQIP database was retrospectively analyzed from 2020 to 2022, comparing laparoscopic and robotic CBS. Primary outcomes were 30-day serious complications and mortality. RESULTS: Of 72,189 CBS procedures, 75.4% were laparoscopic and 24.6% robotic. Mean age and BMI were similar between groups. The most common indications for both approaches were reflux, weight regain, and inadequate weight loss, with reflux being more prevalent in robotic CBS (38.3% vs 33.2%). Sleeve-to-bypass was the most common procedure in both groups (35.8% laparoscopic, 44.2% robotic). Robotic CBS had longer mean operative times (165.4 vs 121.7 min, p < 0.001) and slightly longer hospital stays (1.7 vs 1.6 days, p < 0.001). The rate of serious complications was slightly higher for robotic CBS, though not statistically significant (6.5% vs 6.1%, p = 0.08). Robotic CBS had higher rates of leak (0.9% vs 0.7%, p = 0.071), reoperation (2.8% vs 2.6%, p = 0.138), and readmission (6.7% vs 5.4%, p < 0.001). Mortality rates were similar (0.1% for both, p = 0.942). CONCLUSIONS: Both laparoscopic and robotic CBS show similar safety profiles with comparable mortality rates. However, robotic CBS was associated with longer operative times, slightly longer hospital stays, and higher readmission rates. These findings suggest that the choice between approaches should consider individual patient factors and institutional expertise.