Abstract
Objective: Revisional bariatric surgery (RBS) constitutes up to 15% of all bariatric procedures, with Roux-en-Y gastric bypass (RYGB) being commonly performed as a conversion procedure after adjustable gastric banding (AGB), vertical sleeve gastrectomy (VSG), or vertical banded gastroplasty (VBG), and VSG being frequently performed as a conversion procedure after AGB or VBG. The optimal surgical approach—laparoscopic versus robotic—remains debated. This study aimed to compare laparoscopic and robotic conversion approaches for RBS. Methods: A retrospective case–control study was conducted that included patients who underwent conversion procedures between January 2013 and December 2023 at two centers in Switzerland. Patients were matched on the basis of their index (AGB or stapled procedures) and revisional surgery (RYGB or VSG). The outcomes included early postoperative complications, intensive care unit admissions, operative times, and lengths of hospital stay. Results: A total of 59 conversion procedures were performed, with 46 patients included after matching for revisional and index procedures: 23 in the robotic group and 23 in the laparoscopic group. The baseline characteristics of the patients in both groups were not significantly different. The operative time was significantly shorter in the laparoscopic group (160.7 ± 55.1 min vs. 234.9 ± 61.4 min, p = 0.001). The overall early postoperative complication rates were similar between the groups (13.0% in the laparoscopic group vs. 17.4% in the robotic group, p = 0.681). Although numerically greater in the laparoscopic group, no statistically significant difference was observed between groups regarding major postoperative complications (13.0% vs. 0.0%, p = 0.073). All three patients with complications in the laparoscopic group required multiple reoperations, but none of the patients in the robotic surgery group required reoperation (13.0% vs. 0.0%, p = 0.073). Conclusion: Although major complications and reoperations were numerically less frequent in the robotic group, this potential benefit must be balanced against the significantly longer operative time associated with the robotic approach. Larger studies are needed to clarify whether the numerical differences observed reflect a true clinical effect.