Robotic vs laparoscopic Roux-en-Y gastric bypass in patients with super-super obesity - results of over 230 000 patients using the MBSAQIP database.

Background Patients with a BMI (Body Mass Index) ≥ 60kg/m² are at high risk for bariatric surgery. They have higher complication rates, longer length of stay and greater technical difficulties with surgery. Surgical robots offer better ergonomics and precision, which facilitate surgery. The role of the robot in patients with super-super obesity (BMI ≥ 60) surgery has not been adequately evaluated. Objectives This study reports data of over 230,000 patients regarding bariatric surgery. We aim to compare the results of laparoscopic and robotic RYGB in patients with BMI ≥ 60. Setting: MBSAQIP database Methods Patients aged 18–80 years who underwent Roux-en-Y gastric bypass (RYGB) were included using the 2020–2023 MBSAQIP database. We compared the 30-day outcomes of laparoscopic versus robotic RYGB in patients with BMI < 60 versus BMI ≥ 60. Results There are 233,828 patients in this study. Patients with BMI ≥ 60 as compared to BMI < 60 were more likely to have postoperative complications (5,23% vs 4,44%, p = 0,039), acute renal failure (0,23% vs 0,07%, p = 0,007), unplanned admission to ICU (1,08% vs 0,73%, p = 0,029) and Emergency Department visits after discharge (12,38% vs 11,02%, p = 0,019). There is no difference in 30-day complication rate between laparoscopic and robotic RYGB in patients with BMI ≥ 60. Conclusions Patients with BMI ≥ 60 have higher rates of complications compared to patients with a BMI < 60. RRYGB seems to be a safe to perform in patients with BMI ≥ 60 with longer average operating time but shorter length of stay. There is still a need for good quality multi-centre prospective research study to define the best approach for patients with super-super obesity.