General Surgery and Center for Minimal Invasive Surgery, Department of Surgical Sciences, University of Torino, Corso A.M. Dogliotti, 14-10126, Torino, Italy.
Obes Surg. 2020 Jan;30(1):11-17. doi: 10.1007/s11695-019-04117-7.
Roux-en-Y gastric bypass (RYGB) is the procedure of choice to manage the failure of primary bariatric surgery. However, the current evidence on the role of the robotic technology in revisional bariatric surgery is very limited. The aim of this study is to report safety and effectiveness of revisional RYGB performed with the DaVinci Robotic Surgical System (R-rRYGB) after failed primary bariatric surgery.
Clinical data of consecutive patients undergoing R-rRYGB were included in a prospectively collected database. Intraoperative findings, early postoperative outcomes, and 1-year follow-up results were considered. Primary outcome was postoperative morbidity rate. Secondary outcomes were conversion to open surgery, length of stay, percentage of excess weight loss (%EWL), resolution of complications, and costs.
A total of 68 patients underwent R-rRYGB at our department from 2011 to 2016. Primary procedures were laparoscopic adjustable gastric banding (n = 10), vertical banded gastroplasty (n = 43), and sleeve gastrectomy (n = 15). Conversion rate to open surgery was 2.9%. Postoperative morbidity rate was 8.8%, with no anastomotic leaks reported. Total cost for surgical procedure was 14,334.7 ± 2920.4 €.
Revisional RYGB is a complex procedure but can be performed with the robotic approach with a low morbidity rate. Weight loss outcomes and resolution of complications of the index procedure are satisfactory.
Roux-en-Y 胃旁路术（RYGB）是治疗原发性减重手术失败的首选方法。然而，目前关于机器人技术在减重手术修正中的作用的证据非常有限。本研究旨在报告达芬奇机器人手术系统（R-rRYGB）在原发性减重手术后失败的情况下进行修正 RYGB 的安全性和有效性。
连续接受 R-rRYGB 的患者的临床数据被纳入一个前瞻性收集的数据库中。考虑了术中发现、早期术后结果和 1 年随访结果。主要结果是术后发病率。次要结果是转为开放手术、住院时间、超重减轻百分比（%EWL）、并发症的解决以及成本。
2011 年至 2016 年，我们部门共有 68 例患者接受了 R-rRYGB。主要手术是腹腔镜可调节胃束带术（n=10）、垂直带型胃成形术（n=43）和袖状胃切除术（n=15）。转为开放手术的比率为 2.9%。术后发病率为 8.8%，无吻合口漏报道。手术总费用为 14334.7±2920.4 欧元。
修正 RYGB 是一项复杂的手术，但可以采用机器人方法进行，发病率较低。指数手术的减重效果和并发症的解决令人满意。
