Outcomes of 1,039 Primary Robotic Gastric Bypass Procedures: A Two-Center Retrospective Cohort with Very Low Anastomotic Leak Incidence.

introductionWhile laparoscopy remains the predominant approach for bariatric procedures, recent national data suggest that robotic platforms are now used in up to 35% of bariatric surgeries (Spurzem et al., Surg Obes Relat Dis 21:372-81, 2025); (Spurzem et al., Surg Endosc 38:6294-304, 2024). As robotic surgery continues to gain popularity, it is important to understand the potential advantages it may offer over conventional laparoscopy. Our aim in this study is to evaluate the short- and long-term outcomes of primary robotic gastric bypass surgery.

methodsThis retrospective cohort study included patients from two high-volume tertiary academic centers in the United States (January 2014–December 2024). We analyzed demographics, comorbidities, BMI, perioperative metrics, and surgical outcomes, including early and late complications, rehospitalizations, and reinterventions.

resultsA total of 1,039 patients underwent primary robotic Roux-en-Y gastric bypass with the mean age of 45.61 ± 12.20 years, and 83.6% female population. There were no conversions to open surgery. Early postoperative complications occurred in 132 (12.70%) patients, predominantly minor (Clavien–Dindo I–II). Major complications (Clavien–Dindo III –V) occurred in 34 (3.27%) patients, including one case of sepsis requiring ICU admission (0.1%) and one 30-day mortality (0.1%). There were no anastomotic leaks. Thirty-day readmission occurred in 91 (8.76%) patients, and early reintervention in 34 (3.27%) patients. Late complications occurred in 127 (12.22%) patients, most commonly small bowel obstruction, and 101 (9.72%) patients required readmission. Late reintervention occurred in 91 (8.76%) patients, resulting in a total of 104 reinterventions (10.01%). The estimated 10-year cumulative incidence was 9% for small bowel obstruction, 1% for gastrojejunal ulceration, and 13% for late reinterventions. Mean BMI decreased from 43.9 ± 8.5 kg/m² preoperatively to 33.97 ± 10.6 kg/m² at 6 months and 30.22 ± 8.7 kg/m² at 12 months, corresponding to total body weight loss of 20.96% and 22.84%, respectively.

conclusionRobotic-assisted gastric bypass is safe and effective, with complication rates similar to or even lower than laparoscopic RYGB. The extremely low leak rate (0.1%) suggests robotic assistance may further reduce serious complications, highlighting its growing role in metabolic and bariatric surgery (MBS).