Three Hundred Four Robotically Assisted Biliopancreatic Diversion with Duodenal Switch Operations with Gradual Robotic A
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ORIGINAL CONTRIBUTIONS
Three Hundred Four Robotically Assisted Biliopancreatic Diversion with Duodenal Switch Operations with Gradual Robotic Approach Implementation: Short-Term Outcomes, Complication Profile, and Lessons Learned Gintaras Antanavicius 1 & Theodoros Katsichtis 1
&
Waed Alswealmeen 1 & Mohammed Assali 1
Received: 31 January 2020 / Revised: 1 June 2020 / Accepted: 4 June 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Setting Community, academic affiliated hospital. Objectives In the recent years, a movement towards robotic-assisted biliopancreatic diversion with duodenal switch (BPD/DS) has reported mixed short-term outcomes. We report our 10-year experience with robotic-assisted BPD/DS in our institution. Methods We conducted a retrospective analysis of 304 consecutive bariatric patients who had robotic or robotic-assisted BPD/ DS from December 2008 to February 2018 from a single operating surgeon. Thirty 30-day and 90-day complication and readmission rates were analyzed. No patient was lost to follow-up. Results The median age of the patients was 45 years (interquartile range (IQR) = 16; range = 20–72). Two hundred ten (69.1%) were female. The median pre-op body mass index (BMI) was 49.2 (IQR = 9; range = 34–79). Median operative time was 253.5 min (IQR = 61; range = 124–463). The median hospital length of stay (LOS) was 2 days (IQR = 2; range = 1–13). Thirty-day follow-up revealed 3 major and 20 minor events in 23 patients (7.6%) while there were 4 major and 7 minor events in 6 (2%) patients after 30 days. There were 15 (5%) readmissions within 30 days and 10 (3.2%) additional readmissions occurred past 30 days, but within 90-day period. A need for going back to operating room was observed in 4 (1.3%) patients within 30 days and an additional 5 (1.6%) needed an operation beyond 30 days, but within 90-day period. There was no anastomotic leak and no mortality recorded. Conclusion Robotic-assisted BPD/DS is safe with low early morbidity and mortality. Keywords Bariatric surgery . Biliopancreatic diversion . Duodenal switch . Complications . Laparoscopy . Robotic surgery
Background
Hypothesis
Biliopancreatic diversion with duodenal switch (BPD/DS) is considered the most effective procedure to achieve and maintain weight loss and comorbidity resolution [1–3]. However, it is not widely performed due to complexity, especially in high body mass index (BMI) patients and reported higher rates of early and late postoperative complications [4, 5].
Robotic technique for biliopancreatic diversion provides superior technical results and consistent outcomes in patients with a wide range of BMI. The robotic technique achieves minimal 30- and 90-day postoperative complication rates and faster recovery—the two most important measurements of quality of care by hospitals and insurance providers.
Introduction * Theodoros Katsichtis [email protected] 1
Institute for Metabolic and Bariatric Surgery, Abington Jefferson Health, 225 Newton Rd, Warminster, PA 18
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