(C-139) Knotless Tissue Control Devices For Robotically-Assisted Hand-Sewn Gastrojejunal Anastomosis In Roux-En-Y Gastric Bypass: A Retrospective Comparative Analysis Of Real-World Data

Background: There is a paucity of data on the comparative outcomes of robotically-assisted hand-sewn gastrojejunal anastomosis for Roux-en-Y gastric bypass (RYGB) using STRATAFIX Spiral Knotless Tissue Control Devices (KTCD; Ethicon, Inc.) vs. alternative means of anastomosis (e.g., stapling).

Objectives: To compare the use of KTCD vs. non-KTCD means of gastrojejunal anastomosis in robotically-assisted RYGB.

Methods: Using the U.S. Premier Healthcare Database (PHD), we identified candidate hospitals in which robotically-assisted RYGB was performed with use of KTCD between 01/01/2016-9/30/2022 (first RYGB=index admission); candidate hospitals were approached to verify that KTCD were used for the complete hand-sewn gastrojejunal anastomosis and invited to participate in a retrospective chart review. A comparative control cohort in which no KTCD were used was also established using the PHD during the same timeframe, from among all eligible discharges in the PHD. Stable balancing weights, an optimization-based analogue to propensity score weighting, were used to balance the cohorts on multiple patient, provider, and hospital characteristics. Outcomes, assessed using the PHD in both cohorts, included length of stay (LOS) for the index admission as well as a composite of complications through 90 days following the index discharge, including anastomotic leak, bleeding, dilation of small intestine, infection, pelvic abscess and ileus/bowel obstruction.

Results: A total of 145 patients in 2 hospitals from one health system met the study selection criteria for the robotically-assisted hand-sewn gastrojejunal anastomosis cohort; 6,491 patients met the criteria for the control cohort. All covariates were balanced after weighting. LOS was significantly lower for patients who received KTCD vs. alternative means of anastomosis (1.34 vs. 1.62 days, p< 0.001). The composite of complications at 90 days was also significantly lower for patients who received KTCD vs. alternative means of anastomosis (1.4% vs. 7.7%, p< 0.001).

Conclusions: In this retrospective analysis of patients undergoing robotically-assisted RYGB, we found that the use of KTCD for complete hand-sewn gastrojejunal anastomosis was associated with lower length of stay and a lower incidence of complications at 90 days as compared with alternative means of anastomosis such as non-KTCD sutures or stapling.