Robotic Hand-Sewn Versus Linear-Stapled Gastrojejunostomy in Robotic Roux-en-Y Gastric Bypass for Primary and Revisional Metabolic and Bariatric Surgery: German Experience from a Single Center Study.

backgroundGastrojejunostomy (GJ) anastomosis in Roux-en-Y gastric bypass (RYGB) can be performed using various techniques via minimally invasive surgery (MIS). This study evaluates clinical outcomes of robotic hand-sewn versus linear-stapled GJ anastomosis in primary and revisional metabolic and bariatric surgery (MBS).

methodsThis retrospective study evaluated 64 consecutive patients with severe obesity who underwent robotic Roux-en-Y gastric bypass (RYGB) using the da Vinci Xi system (Intuitive Surgical, Inc., Sunnyvale, CA, USA) at a single center by one surgeon between January 1, 2021, and December 31, 2023. Both primary and revisional procedures were included. Clinical outcomes assessed included 30-day morbidity and mortality, surgical technique (robotic hand-sewn vs. linear-stapled gastrojejunostomy), and the need for re-intervention.

resultsA total of 64 patients underwent robotic RYGB, with the hand-sewn gastrojejunostomy (GJ) technique performed in 24 cases (38%) and the linear-stapled approach in 40 cases (62%). No anastomotic leaks or intraluminal bleeding were reported in either group. However, three patients in the hand-sewn group developed anastomotic stenosis that required endoscopic balloon dilation.

conclusionRobotic RYGB using either hand-sewn or stapled gastrojejunostomy techniques can be safely executed in an accredited MBS referral center. The fully robotic approach facilitates the use of hand-sewn anastomoses in both primary and revisional settings. The occurrence of anastomotic stenoses in the hand-sewn group is likely attributable to the initial learning curve.