Dataset Information

Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches?

ABSTRACT: OBJECTIVE:The aim was to compare clinical outcomes of patients treated with totally robotic Roux-en-Y gastric bypass (TRRYGB) with those treated with the different laparoscopic Roux-en-Y gastric bypass (LRYGB) techniques. The clinical benefit of the robotic approach to bariatric surgery compared to the standard laparoscopic approach is unclear. There are no studies directly comparing outcomes of TRRYGB with different LRYGB techniques. METHODS:Outcomes of 578 obese patients who underwent RYGB between 2011 and 2014 at an academic center were assessed. Multivariable analysis and propensity matching were used for comparing TRRYGB to different LRYGB techniques, including 21-mm EEA circular-stapled gastrojejunal anastomosis (GJA, LRYGB-21CS), linear-stapled GJA (LRYGB-LS), and hand-sewn GJA (LRYGB-HS). RESULTS:The TRRYGB technique required a longer mean operative time compared to the other groups, respectively 204?±?46 vs. 139?±?30 min (LRYGB-21CS), 206?±?37 vs. 158?±?30 min (LRYGB-LS), and 210?±?36 vs. 167?±?30 min (LRYGB-HS). TRRYGB experienced a lower stricture rate (2 vs. 17%, P?=?0.003), shorter hospital stay (2.6?±?1.2 vs. 4.3?±?5.5 days, P?=?0.008), and lower readmission rate (12 vs. 28%, P?=?0.009). No significant differences in outcomes were observed when comparing RRYGB to LRYGB-LS or LRYGB-HS. CONCLUSIONS:TRRYGB increases operative time compared to all LRYGB techniques. TRRYGB was superior to LRYGB-21CS in terms of significantly shorter hospital stay, lower readmission rate, and less frequent GJA stricture formation. TRRYGB provides no clinical advantages over the LRYGB-LS and LRYGB-HS techniques.

SUBMITTER: Rogula T

PROVIDER: S-EPMC6132787 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:Phase and step annotation in surgical videos is a prerequisite for surgical scene understanding and for downstream tasks like intraoperative feedback or assistance. However, most ontologies are applied on small monocentric datasets and lack external validation. To overcome these limitations an ontology for phases and steps of laparoscopic Roux-en-Y gastric bypass (LRYGB) is proposed and validated on a multicentric dataset in terms of inter- and intra-rater reliability (inter-/intra-RR). The proposed LRYGB ontology consists of 12 phase and 46 step definitions that are hierarchically structured. Two board certified surgeons (raters) with > 10 years of clinical experience applied the proposed ontology on two datasets: (1) StraBypass40 consists of 40 LRYGB videos from Nouvel Hôpital Civil, Strasbourg, France and (2) BernBypass70 consists of 70 LRYGB videos from Inselspital, Bern University Hospital, Bern, Switzerland. To assess inter-RR the two raters' annotations of ten randomly chosen videos from StraBypass40 and BernBypass70 each, were compared. To assess intra-RR ten randomly chosen videos were annotated twice by the same rater and annotations were compared. Inter-RR was calculated using Cohen's kappa. Additionally, for inter- and intra-RR accuracy, precision, recall, F1-score, and application dependent metrics were applied. The mean ± SD video duration was 108 ± 33 min and 75 ± 21 min in StraBypass40 and BernBypass70, respectively. The proposed ontology shows an inter-RR of 96.8 ± 2.7% for phases and 85.4 ± 6.0% for steps on StraBypass40 and 94.9 ± 5.8% for phases and 76.1 ± 13.9% for steps on BernBypass70. The overall Cohen's kappa of inter-RR was 95.9 ± 4.3% for phases and 80.8 ± 10.0% for steps. Intra-RR showed an accuracy of 98.4 ± 1.1% for phases and 88.1 ± 8.1% for steps. The proposed ontology shows an excellent inter- and intra-RR and should therefore be implemented routinely in phase and step annotation of LRYGB.

Project description:IMPORTANCE:There is conflicting evidence about how different bariatric procedures impact health care use. OBJECTIVE:To compare the impact of laparoscopic adjustable gastric banding (AGB) and laparoscopic Roux-en-Y gastric bypass (RYGB) on health care use and costs. DESIGN, SETTING, AND PARTICIPANTS:Retrospective interrupted time series with comparison series study using a national claims data set. The data analysis was initiated in September 2011 and completed in January 2015. We identified bariatric surgery patients aged 18 to 64 years who underwent a first AGB or RYGB between 2005 and 2011. We propensity score matched 4935 AGB to 4935 RYGB patients according to baseline age group, sex, race/ethnicity, socioeconomic variables, comorbidities, year of procedure and baseline costs, emergency department (ED) visits, and hospital days. Median postoperative follow-up time was 2.5 years. MAIN OUTCOMES AND MEASURES:Quarterly and yearly total health care costs, ED visits, hospital days, and prescription drug costs. We used segmented regression to compare pre-to-post changes in level and trend of these measures in the AGB vs the RYGB groups and difference-in-differences analysis to estimate the magnitude of difference by year. RESULTS:Both AGB and RYGB were associated with downward trends in costs; however, by year 3, AGB patients had total annual costs that were 16% higher than RYGB patients (P < .001; absolute change: $818; 95% CI, $278 to $1357). In postoperative years 1 and 2, AGB was associated with 27% to 29% fewer ED visits than RYGB (P < .001; absolute changes: -0.6; 95% CI, -0.9 to -0.4 and -0.4; 95% CI, -0.6 to -0.1 visits/person, respectively); however, by year 3, there were no detectable differences. Postoperative annual hospital days were not significantly different between the groups. Although both procedures lowered prescription costs, annual postoperative prescription costs were 17% to 32% higher for AGB patients than RYGB patients (P < .001). CONCLUSIONS AND RELEVANCE:Both laparoscopic AGB and RYGB were associated with flattened total health care cost trajectories but RYGB patients experienced lower total and prescription costs by 3 years postsurgery. On the other hand, RYGB was associated with increased ED visits in the 2 years after surgery. Clinicians and policymakers should weigh such differences in use and costs when making recommendations or shaping regulatory guidance about these procedures.

Dataset Information

Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches?

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets