Robotic hand-sewn vs. laparoscopic linear-stapled Roux-en-Y gastric bypass: a propensity score-matched analysis of primary and conversion cases

Background Roux-en-Y gastric bypass (RYGB) is performed as a primary procedure or as a conversion from sleeve gastrectomy for complications such as gastroesophageal reflux disease (GERD) or weight regain. Robotic hand-sewn gastrojejunostomy may improve precision compared with laparoscopic linear stapling, but comparative evidence remains limited. This study compared robotic hand-sewn and laparoscopic linear-stapled RYGB using propensity score matching (PSM). Methods This retrospective cohort study included 67 patients undergoing primary or conversion RYGB at a Saudi tertiary center (2016–2024). After PSM, 26 robotic cases (11 primary, 15 conversion) were matched with 26 laparoscopic cases based on demographic and clinical variables. Outcomes included operative time, length of stay (LOS), postoperative pain, narcotic use, complications, costs, body mass index (BMI) reduction, and comorbidity improvement. Statistical significance was set at p 0.05. Results Matched groups were comparable (mean age 46 ± 8 years; BMI 41 ± 6 kg/m²). Robotic procedures had longer operative times (178 ± 25 vs. 158 ± 22 min, p 0.001) and higher costs (21,500 vs. 11,500 Saudi riyals, p 0.001). LOS was slightly shorter in the robotic group (1.8 ± 0.5 vs. 2.1 ± 0.5 days, p = 0.19). Pain scores were lower (2.1 ± 0.8 vs. 3.4 ± 1.1, p = 0.002), and narcotic use was reduced (32% vs. 69%, p = 0.01). Complication rates and 12-month outcomes were comparable. Conclusion Robotic and laparoscopic RYGB show comparable efficacy and safety. The robotic approach reduces pain and narcotic use, with a trend toward shorter hospital stay, but increases operative time and costs, supporting selective use in complex cases.