Primary Versus Revisional Robotic Roux-en-Y Gastric Bypass: A High-Volume Single-Center Analysis

Background: Evidence regarding outcomes after robotic revisional Roux-en-Y gastric bypass (RYGB) is scarce. We aimed to compare outcomes between primary and revisional robotic RYGB. Methods: We performed a retrospective analysis of a consecutive series of patients undergoing robotic RYGB between 2015 and 2022. Demographics, postoperative results, and metabolic outcomes were compared between primary RYGB (pRYGB) and revisional RYGB (rRYGB). Results: In total, 530 patients were included; 416 pRYGB and 114 rRYGB. Insufficient weight loss was the most frequent indication for rRYGB (74.6%). Clavien IIIb complications were significantly more frequent in rRYGB patients (4.4% vs. 1.2%, p = 0.04). Hospital stay was longer after rRYGB (1.8 vs. 1.6 days, p < 0.001). At 12 months, pRYGB had greater mean percentage total weight loss (%TWL) than rRYGB (29 ± 9 vs. 18 ± 11, p < 0.001). Hypertension was improved (14% vs. 8.6%, p = 0.02) and resolved (8.4% vs. 1.7%, p = 0.02) in a greater proportion after pRYGB. Diabetes improvement and resolution were similar in both groups. Conclusions: Robotic rRYGB is safe and effective. However, morbidity is higher, weight loss is lower, and metabolic outcomes are poorer as compared with pRYGB. Appropriate patient selection, skilled surgical teams, and close postoperative care are vital for optimizing outcomes after rRYGB.