Robotic versus laparoscopic one anastomosis gastric bypass (OAGB): a propensity score-matched comparative study of perioperative outcomes in 200 patients

Abstract Background Severe obesity poses a substantial health burden, often necessitating surgical intervention. One anastomosis gastric bypass (OAGB) has emerged as a reliable bariatric procedure. In recent years, robotic-assisted surgery has gained traction due to its potential advantages over conventional laparoscopic techniques. However, comparative data on the outcomes of robotic versus laparoscopic OAGB remain limited. Objectives This pilot study aims to evaluate the surgical outcomes of robotic versus laparoscopic OAGB, focusing on safety, feasibility, and postoperative recovery. The primary endpoints include operative duration, intraoperative and postoperative complications, postoperative pain, and length of hospital stay. Materials and methods A retrospective analysis was conducted on 241 patients who underwent primary OAGB at the Bariatric and Endocrine-Metabolic Surgery Unit, University of Naples "Federico II," between January 2023 and December 2025. After propensity score matching, 100 patients underwent robotic OAGB utilizing the Da Vinci Xi® system and 100 laparoscopic OAGB. Results Baseline demographic characteristics were comparable between groups. The robotic-assisted procedure exhibited a longer mean operative time (112.90 ± 10.70 min vs. 107.70 ± 12.48 min; p = 0.018). No intraoperative complications or conversions to laparoscopy or open surgery were recorded. Robotic group reported lower postoperative pain scores on postoperative day 1 ( p < 0.0001). No significant differences were observed regarding mean hospital stay, postoperative nausea, vomiting, or overall complication rates. Conclusions These preliminary findings suggest that r-OAGB is an efficient and safe alternative to laparoscopic approach. However, larger prospective studies are warranted to validate these results and assess long-term outcomes and cost-effectiveness.