Roux-en-Y gastric bypass: systematic review and Bayesian network meta-analysis comparing open, laparoscopic, and robotic approach

The Roux-en-Y gastric bypass (RYGB) is performed via an open (OpenRYGB), laparoscopic (LapRYGB), or robotic (RoRYGB) approach. Previous review evidence is limited to pairwise meta-analysis, and RoRYGB versus OpenRYGB comparison is lacking. The aim of this network meta-analysis was to globally compare short-term outcomes within the open, laparoscopic, and robotic surgical approaches to RYGB. PubMed, EMBASE, and Web of Science databases were consulted. A fully Bayesian network meta-analysis was performed to compare OpenRYGB, LapRYGB, and RoRYGB. Nineteen studies, for a total of 276,732 patients, were included. Overall, 28.8% of the patients underwent OpenRYGB, 67.3% LapRYGB, and 3.9% RoRYGB. The 30-day mortality was significantly lower for both LapRYGB and RoRYGB versus OpenRYGB (risk ratio [RR] = .64, 95% credible interval [CrI] .46-.97, and RR = .49, 95% CrI .24-.99, respectively). The overall complication rate was significantly lower for both LapRYGB and RoRYGB versus OpenRYGB (RR = .63, 95% CrI .42-.91, and RR = .60, 95% CrI .33-.95, respectively). Anastomotic leak rate was similar for LapRYGB and RoRYGB versus OpenRYGB (RR = 1.10, 95% CrI .67-1.81, and RR = .95, 95% CrI .45-2.12, respectively). Surgical site infection (RR = .42, 95% CrI .30-.75, and RR = .24; 95% CrI .13-.58, respectively) and pulmonary complications (RR = .57, 95% CrI .45-.77, and RR = .42; 95% CrI .25-.76, respectively) were significantly lower for LapRYGB and RoRYGB versus OpenRYGB. No differences were found when postoperative bleeding, thromboembolic complication, 30-day reoperation, and 30-day hospital readmission were considered. This network meta-analysis suggests that both LapRYGB and RoRYGB appear to be safer compared to OpenRYGB with regard to 30-day mortality, overall complication rate, surgical site infection rate, and pulmonary complication rate. The surgical management of morbid obesity through RYGB is evolving, and the adoption of innovative minimally invasive techniques may improve patient outcomes.