Robotic Revisional Single Anastomosis Duodenoileal Bypass After Sleeve Gastrectomy.

Abstract

Introduction: Single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) is a metabolic operation emerging as an option for patients with morbid obesity. It is a promising revisional procedure for weight regain or suboptimal weight loss after sleeve gastrectomy (SG). Currently, there is limited literature describing robotic revisional SADI-S. This study describes the safety, feasibility, and early outcomes of robotic revisional SADI-S after previous SG. Methods: This is a retrospective review from May 26 2019 to January 31 2021. Perioperative outcomes were analyzed. Results: A total of 16 patients underwent the procedure. There were 11 females (69%) with a mean age of 39 ± 11 years. Mean body mass index (BMI) was 44.0 ± 5.1 kg/m2 and median ASA was two. Comorbidities included hypertension (25%), hyperlipidemia (19%), and obstructive sleep apnea (13%). Mean interval from primary to revisional surgery among patients was 5.5 ± 1.4 years. Median operative console time was 110 minutes (IQR = 103-137). There were no intraoperative complications. The median hospital stay was 2 days (IQR = 2-3). Perioperative outcomes included no reoperations, perioperative complications, or deaths. There were two (12.5%) emergency department visits for wound checks without infection but no readmissions. At a median follow-up of 4.5 months (IQR = 1-10), patients had a mean BMI of 38.3 ± 7.3 kg/m2 and a mean percent total body weight loss (%TBW) of 12.7%. Conclusions: Initial outcomes suggest that robotic revisional SADI-S after previous SG is feasible and safe. Future studies are needed to evaluate intermediate- and long-term postoperative outcomes.