David Matthew Parker

Introduction Roux-en-Y gastric bypass (RYGB) has been well-established as a metabolic surgical procedure; however, long-term follow-up data is limited. The purpose of this study is to evaluate long-term (> 15 year) outcomes following RYGB. Methods A retrospective review of RYGB performed at a single COE from 2001–2008 was conducted. Primary outcomes were mean percent total body weight loss (TBWL) (using repeated measures regression), percent with diabetes (compared between insulin and non-insulin using chi-square test), post-RYGB. Results During the analysis period, there were 2045 patients that underwent RYGB. Ten years or more of follow-up was available for 68% of the patients (n = 1388) and 48% had > 15 years of follow-up (n = 987). Preoperative mean age was 46 (18–72) and BMI (kg/m2) 47.9 (35–82.2). Maximum mean post-RYGB TBWL of 31.8% occurred at 18 months post-operatively. Mean TBWL stabilized at 23% at 10–20 years post-RYGB. Of the 677 patients with pre-operative diabetes, 10% were insulin-dependent post-RYGB. Diabetes remission rates were 54% at 3 years but decreased to 38% at 15 years. The rate of persistent diabetes post-RYGB was higher in pre-operative insulin-treated diabetes (p < 0.0001). Conclusion Our study represents one of the largest studies of long-term follow data for patients undergoing RYGB. Our data demonstrates that RYGB is successful in providing sustained, long-term, weight loss and diabetes remission.

Introduction A preponderance of studies demonstrates that longer operative times lead to poorer outcomes across surgical specialties and operative approaches. The objective of this study was to examine operative time trends and associated perioperative outcomes in robotic bariatric metabolic surgery compared to the laparoscopic approach. Methods Robotic (RA) and laparoscopic (L) sleeve gastrectomy (SG) and gastric bypass (RYGB) were compared using the 2015–2023 MBSAQIP data. A total of 467,954 patients were propensity score matched 1:1 (age, BMI, sex, comorbidities). Results Median operative times were significantly longer for both RA-SG (80 vs. 58 min; p < 0.01) and RA-RYGB (133 vs. 107 min; p < 0.01) compared with laparoscopic. Over the study period, the difference in median operative times for RA-RYGB vs. L-RYGB along with RA-SG vs. L-SG has decreased (p < 0.01) but not continuously. Operative times for all groups have decreased significantly over the study period (p < 0.01). For both RYGB and SG surgeries, the robotic groups had significantly higher rates of reoperation, readmission, reintervention, and emergency department (ED) visits within the 30-day perioperative window. There were no significant differences in mortality. Conclusion Despite a tenfold increase in annual robotic case volume over 8 years, robotic bariatric operative times remain significantly longer in every year of MBSAQIP data (RA-SG + 28%, p < 0.01; RA-RYGB + 18%, p < 0.01). Longer operative times in the propensity-matched cases are associated with worse 30-day perioperative outcomes for the robotic groups (higher reoperation rates, readmissions, reinterventions, and ED visits). These data imply the surgical community is complicit in both the rising cost of healthcare and the exposure of patient harm despite no identifiable clinical benefit.

Introduction Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) constitute the most commonly performed bariatric metabolic surgery (BMS) procedures in the USA. The number of robotic-assisted BMS cases remains low, primarily due to the increased cost and extended operative time associated with this technology. Our primary objective is to assess whether robotic platform reduces the need for a surgical first assistant (FA). Our secondary objective is to compare the utilization of skilled surgical assistants. Methods We conducted a retrospective analysis of the MBSAQIP Participant Use File cohort spanning from 2015 to 2019 to determine the prevalence of Attending Surgeon involvement in robotic-assisted, laparoscopic RYGB, and SG procedures, in comparison to non-physician surgical First Assistants. Cases involving medical trainees (residents and fellows) were excluded from the analysis. For each bariatric procedure, we established two distinct groups and employed propensity score matching to ensure patient comparability. A “good match” was defined as a standardized mean difference (SMD) of less than 0.10. All statistical analyses were two-sided, with a significance level set at P < 0.05. Results A total of 113,682 patients underwent LRYGB, with 12,480 undergoing robotic RYGB (RRYGB). After a 1:1 match, attending-level FAs were involved in 25.9% of LRYGB cases, mid-level FAs in 55.6%, and no assistants in 18.5%. In contrast, RRYGB cases utilized attending-level FAs in 13.7% of cases, mid-level FAs in 68.4%, and had no assistants in 17.9% of cases (P < 0.0001). In LSG, attending-level FAs were present in 28.1% of cases, mid-level FAs in 51.6%, and no assistants in 20.3%. In comparison, robotic SG (RSG) cases had attending-level FAs in 16.1%, mid-level FAs in 55.6%, and no assistants in 28.3% of cases (P < 0.0001). Conclusion The robotic platform failed to show a reduction in the need for an assistant in Roux-en-Y Gastric Bypass (RYGB) procedures but did lead to a decrease in the number of assistants required in sleeve gastrectomy (SG). Mid-level assistance was necessary for the majority of robotic and laparoscopic bariatric metabolic cases. The robotic platform was associated with an approximate 12% reduction in the requirement for attending-level assistance in robotic procedures.