Roux-en-Y gastric bypass (RYGB) surgeries are commonly performed in the bariatric surgery niche. The pros and cons of conventional laparoscopic procedures (conventional laparoscopic RYGB) and robotic surgeries (robotic Roux-en-Y gastric bypass [RRYGB]) are not well defined systematically in terms of procedural safety, efficacy, and costs.
Objectives:
To systematically assess the efficacy, safety, and cost profiles of LRYGB versus RRYGB surgeries among patients with morbid obesity.
Methods:
A systematic review and meta-analysis were conducted, including studies that compared LRYGB and RRYGB surgeries in terms of the overall cost per procedure (CPP), operative time, length of hospital stay (LOS), postoperative complications, and in-hospital mortality. The overall costs were adjusted to 2020 U.S. dollars to account for the inflation rates. The outcomes were pooled using standardized mean differences (SMDs) and relative risks (RRs) for numerical and categorical variables, respectively.
Results:
Thirty studies (one randomized clinical trial) met the eligibility criteria (109,279 patients, 20.52% underwent RRYGB). Compared with LRYGB, RRYGB surgeries were associated with longer operative times (SMD = 0.80, 95% confidence interval [CI]: 0.24 to 1.36, p = 0.005), higher overall CPP (SMD = 0.33, 95% CI: 0.30 to 0.37, p < 0.0001) and lower risks of wound infection (RR = 0.47, 95% CI: 0.25 to 0.88, p = 0.018) and intraabdominal bleeding (RR = 0.49, 95% CI: 0.32 to 0.76, p = 0.001). No significant differences were noted in other complications, postoperative LOS, and in-hospital mortality.
Conclusion:
Future high-quality, randomized studies are required to guide clinical decisions regarding the optimal surgical technique that would reduce patient morbidity and mortality while reducing the expected costs. The role of surgeons' expertise and cost-reducing strategies should also be stressed in future research.
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