Minimally invasive versus open duodenal switch: a nationwide retrospective analysis

Abstract

Introduction: This study aims to characterize the variability in clinical outcomes between open, laparoscopic, and robotic Duodenal Switch (DS).

Methods: From the Metabolic and Bariatric Surgery and Accreditation Quality Improvement Program, patients who underwent DS (2015-2018) were identified. Open DS was compared to laparoscopic and robotic approaches with for patients factors, perioperative characteristics, and 30-day postoperative outcomes. Logistic regression estimates were used to characterize variables associated with surgical site infections, bleeding, reoperation, readmission, and early discharge (hospital stay of ≤ one day).

Results: Of 7649 cases, 411 (5.4%) were open, 5722 (74.8%) were laparoscopic, and 1515 (19.8%) were robotic DS. Open DS patients were more often older (≥ 65 years:4.7% vs. 4.3% vs. 2.1%, p < 0.01) and had lower body mass index (< 40 kg/m²:16.3% vs. 10.5% vs. 9.9%, p < 0.01). The co-morbidities were mainly comparable between the three groups. Open DS was more often without skilled assistance (35.3% vs. 12.1% vs. 5.3%, p < 0.01), revisional (41.4% vs. 20.5% vs. 21.3%, p < 0.01), and performed concurrently with other operations. Robotic DS surgery was more often longer (≥ 140 min:64.4% vs. 39.2% vs. 86.9%, p < 0.01). Post-operatively, open DS was associated with higher rates of surgical site infection (7.1% vs. 2% vs. 2.8%, p < 0.01), bleeding (2.4% vs. 0.7% vs. 0.9%, p = 0.001), reoperation (6.6% vs. 3.6% vs. 4.4%, p = 0.01), and readmission (12.4% vs. 6.8% vs. 8.3%, p = < 0.01). Patients undergoing robotic DS were more often discharged early (0.5% vs. 1% vs. 7.8%, p < 0.01). In the regression analyses, minimally invasive DS was associated with lower odds for wound infections (OR = 0.3,CI = [0.2-0.5]), bleeding (OR = 0.4,CI = [0.2-0.8]), and readmission (OR = 0.6,CI = [0.4-0.8]), as well as greater likelihood of early discharge (OR = 5.6 CI = [1.3-23.0]).

Conclusion: Open DS is associated with greater risk for complications and excessive resource utilization when compared to minimally invasive approaches. Laparoscopic and robotic techniques should be prioritized in performing DS, despite the complexity of the procedure.

Keywords: Bariatric; Duodenal Switch; Laparoscopy; Minimally Invasive; Outcomes; Robot.