Robotic RYGB is Associated with Increased Risk of Early Postoperative Small Bowel Obstruction: an Analysis of 188,213 MBSAQIP Cases

Introduction: Small bowel obstruction (SBO) represents a serious early complication following Roux-en-Y gastric bypass (RYGB) surgery. With the widespread adoption of robotic platforms in bariatric surgery, understanding the impact of robotic assistance on postoperative complications has become increasingly important. However, the association between robotic assistance and early SBO risk remains unclear in the current literature. This study aimed to evaluate the relationship between robotic assistance and early postoperative small bowel obstruction following primary RYGB procedures. Methods and Procedures: We conducted a retrospective cohort study analyzing the 2020–2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from over 900 accredited bariatric surgery centers across the United States and Canada. Patients undergoing primary RYGB were stratified by occurrence of 30-day SBO. The primary outcomes evaluated were early postoperative small bowel obstruction rates, reoperation rates, and readmission rates. Multivariable logistic regression was used to identify independent predictors of SBO, adjusting for patient demographics, comorbidities, and operative factors. Results: A total of 188,213 RYGB procedures were included in the study, with 1,704 patients (0.9%) developing early SBO. Robotic assistance was utilized in 29.2% of cases. Baseline characteristics showed that SBO patients were predominantly female (90.1% vs. 83.4%, p < 0.001) with lower BMI (43.6 vs. 45.5 kg/m², p < 0.001) and longer operative times (141.7 vs. 124.7 min, p < 0.001). SBO occurred more frequently with robotic assistance compared to conventional approaches (1.2% vs. 0.8%, p < 0.001), representing an absolute risk difference of 0.4% or approximately 4 additional SBO cases per 1,000 robotic procedures. Multivariable analysis confirmed robotic assistance as an independent risk factor for early SBO (OR 1.30, 95% CI 1.17–1.44, p < 0.001), alongside female sex (OR 1.76) and VTE history (OR 1.55). SBO cases showed significantly higher reoperation rates (54.7% vs. 1.2%) and readmission rates (75.1% vs. 4.1%) compared to patients without SBO. Conclusion: Robotic assistance is independently associated with increased early SBO risk following RYGB (OR 1.30, absolute risk 1.2% vs. 0.8%, 4 additional cases per 1,000 procedures). While the absolute risk increase is modest, these findings necessitate balanced patient counseling that incorporates both this increased early SBO risk and potential benefits of robotic approaches. These results support the development of standardized robotic protocols to mitigate SBO occurrence while leveraging the advantages of robotic technology in bariatric surgery centers.