title: Robot-assisted Roux-en-Y gastric bypass for super obese patients: a comparative study.
abstract: Superobese patients (SO) (body mass index (BMI) ≥ 50 kg/m(2)) represent a real surgical challenge and the best management remains debatable. While the safety of a laparoscopic approach has been questioned for this population, robotics has been introduced in the armamentarium of the bariatric surgeon, yet its role remains poorly assessed, especially for a very high BMI. The study aim is thus to report our experience with robot-assisted Roux-en-Y gastric bypass (RYGB) for SO. From July 2006 to May 2012, 288 consecutive robot-assisted RYGB procedures have been performed at a single institution. All data were collected prospectively in a dedicated database. Among those patients, 41 were SO (14.2 %). All the peri- and postoperative parameters were compared to the morbidly obese (MO) group (BMI < 50). Data have been reviewed retrospectively. The SO group presented a higher ASA score and more male patients. The operative time was similar between both groups, yet there were more conversions in the SO group (two versus one for MO; p = 0.05). The morbidity and mortality rates were similar between both groups. The length of stay was longer for the SO population (7 vs. 6 days; p = 0.03). The percent BMI loss was similar at 1 year (34 vs. 34 %; p = 1), but the percent excess BMI loss was higher for the MO group (83 vs. 65 % for the SO group; p = 0.0007). Robot-assisted RYGB can be performed safely for SO, with complication rates and functional results at 1 year comparable to MO, yet this approach for SO has been associated with a slightly increased conversion rate and length of stay.
authors.affiliation: Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Rue Gabriel-Perret-Gentil 4, 1211, Geneva, Switzerland. Nicolas.c.buchs@hcuge.ch
authors.forename: Nicolas C
authors.initials: NC
authors.lastname: Buchs
authors.forename: François
authors.initials: F
authors.lastname: Pugin
authors.forename: Gilles
authors.initials: G
authors.lastname: Chassot
authors.forename: Francesco
authors.initials: F
authors.lastname: Volonte
authors.forename: Pascale
authors.initials: P
authors.lastname: Koutny-Fong
authors.forename: Monika E
authors.initials: ME
authors.lastname: Hagen
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D061646:Operative Time; D012189:Retrospective Studies; D012371:Robotics; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome; D015431:Weight Loss