Safety and Efficiency of Robotic Versus Laparoscopic Revisional Bariatric Surgery: A Systematic Review and Meta-Analysis

Abstract

Background: Revisional bariatric surgery is increasingly performed due to weight regain, inadequate weight loss, or complications following primary bariatric procedures. These operations are technically challenging, and while laparoscopic surgery remains the standard approach, robotic platforms have gained adoption. However, comparative evidence on safety and efficiency remains limited and methodologically heterogeneous. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed/Medline, Embase, Scopus, Web of Science, and Cochrane Central were searched. Comparative studies of robotic versus laparoscopic revisional bariatric surgery were included. To reduce bias from overlapping cohorts, we systematically identified and excluded duplicate datasets from national and institutional registries, prioritising the most contemporary and comprehensive reports, and retained partially overlapping studies only when the non-overlapping period spanned ≥3 years. Study quality was assessed using the Newcastle–Ottawa Scale. Outcomes analysed included length of hospital stay, operative time, postoperative complications, reoperation, anastomotic leakage and pneumonia. Random-effects models were used to generate pooled estimates. Results: Six retrospective studies encompassing 7199 robotic and 34,584 laparoscopic procedures were included. Robotic surgery was associated with a statistically significant reduction in length of hospital stay compared with laparoscopy (mean difference −1.06 days; 95% CI −1.97 to −0.15; I2 = 84%). This finding was sensitive to the inclusion of a single large registry-based study. No significant differences were observed in the overall postoperative complications, reoperation rates, anastomotic leakage or pneumonia. Operative time did not differ significantly in the primary analysis. (I2 = 93%), but sensitivity analyses suggested shorter procedure durations with laparoscopic surgery after exclusion of influential studies. Conclusions: In this systematic review and meta-analysis, robotic revisional bariatric surgery was associated with a shorter length of hospital stay and similar short-term safety outcomes to laparoscopic surgery. However, the very high statistical heterogeneity, observational design and potential for selection bias mean that these findings should be interpreted as hypothesis-generating rather than definitive evidence of superiority or equivalence. Larger, prospective, multi-centre studies with standardised outcome definitions and robust adjustment for confounding are needed to clarify the comparative clinical and cost-effectiveness of robotic versus laparoscopic approaches in revisional bariatric surgery.