title: Roux-en-Y gastric bypass for super obese patients: what approach?
abstract: BACKGROUND
  Super obese (SO) patients with a Body Mass Index (BMI) ≥ 50 kg/m(2) still represent a real anesthesiological and surgical challenge. While the best procedure to perform in this population remains unclear, robotic technology has been proposed to accomplish Roux-en-Y gastric bypass (RYGB). The study aim is to report our experience of robotic RYGB for SO patients and to compare it with open and laparoscopic surgery.
  
  
  METHODS
  From July 1997 to March 2014, all consecutive RYGB cases for SO patients were collected in a dedicated database and reviewed retrospectively. Two hundred and fourteen SO patients were operated on: 65 by a robotic approach (30.4%), 54 by a laparoscopic approach (25.2%), and 95 using an open approach (44.4%). Peri- and post-operative data were compared between the three approaches.
  
  
  RESULTS
  There were more male patients in the robotic group, but with a slightly lower BMI. The operative time was longer for the robotic (+27 min) and laparoscopic (+21 min) groups in comparison with the open group (P < 0.05). Overall, there were less reoperations (P < 0.05) and a shorter hospital stay (P < 0.05) in the robotic group in comparison with other groups. Of note there was also a trend in favor of robotics with less conversions (P = 0.08) and less postoperative complications (P ≥ 0.05).
  
  
  CONCLUSIONS
  Robotic RYGB can be performed safely in super obese patients with results that compare favorably with laparoscopic and open surgery. However, the robotic approach has a longer operative time. The exact role of robotics for super obese population needs to be clarified in larger and randomized trials before drawing definitive conclusions. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Switzerland.
authors.forename: Nicolas C
authors.initials: NC
authors.lastname: Buchs
authors.affiliation: Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Switzerland.
authors.forename: Dan E
authors.initials: DE
authors.lastname: Azagury
authors.affiliation: Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Pugin
authors.affiliation: Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Switzerland.
authors.forename: Minoa K
authors.initials: MK
authors.lastname: Jung
authors.affiliation: Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Huber
authors.affiliation: Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Switzerland.
authors.forename: Gilles
authors.initials: G
authors.lastname: Chassot
authors.affiliation: Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
mesh_terms: D000328:Adult; D000465:Algorithms; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D015992:Body Mass Index; D016208:Databases, Factual; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications; D011184:Postoperative Period; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome
keywords: gastric bypass; laparoscopy; open; outcomes; robot; super obese