Robotic versus laparoscopic Roux-en-Y gastric bypass: a propensity-matched comparison of the inflammatory response and MASLD trajectories

Roux-en-Y gastric bypass (RYGB) is among the most common surgical procedures for treatment of obesity and metabolic comorbidities and routinely performed using either a laparoscopic- (L-RYGB) or a robotic (R-RYGB) approach. Although overall outcomes are comparable, robotic surgery has been proposed to attenuate postoperative inflammation, which may influence metabolic outcomes. The impact of robotic surgery in RYGB and potential implications for metabolic dysfunction-associated steatotic liver disease (MASLD) remain unclear. We conducted a retrospective cohort study of 306 patients undergoing L- or R-RYGB. Propensity score matching (PSM) was performed to create balanced cohorts with comparable baseline characteristics. We evaluated the postoperative inflammatory response using leukocyte counts and C-reactive protein (CRP), and assessed short-term clinical outcomes, including pain and length of stay (LOS). MASLD trajectories using non-invasive fibrosis scores (NITs) and weight loss were analyzed over one year. After (PSM), R-RYGB was not associated with an altered inflammatory response with comparable postoperative leukocyte and CRP profiles between both approaches. Patients undergoing R-RYGB reported lower postoperative pain and had a shorter LOS, whereas length of surgery was shorter in the L-RYGB group. Weight loss outcomes and MASLD trajectories assessed by NITs were similar one year post-surgery. L-RYGB and R-RYGB demonstrate comparable postoperative inflammatory responses with similar MASLD trajectories. R-RYGB may offer advantages in the early postoperative recovery at the expense of longer length of surgery.