The Magenstrasse and Mill Operation for Morbid Obesity

Background: Our aim was to evolve a simpler, more physiological type of gastroplasty that would dispense with implanted foreign material such as bands and reservoirs. The Magenstrasse, or "street of the stomach", is a long narrow tube fashioned from the lesser curvature, which conveys food from the esophagus to the antral Mill. Normal antral grinding of solid food and antro-pyloro-duodenal regulation of gastric emptying and secretion are preserved. Methods: 100 patients with morbid obesity (83M, 17F, mean age 40 years) were treated by the Magenstrasse and Mill procedure and followed-up for 1-5 years. Mean preoperative BMI was 46.3 kg/m², and mean excess weight was 106%. Results: Operative mortality was 0. Major complications occurred in 4% of patients.There were few side-effects, although mild heartburn was fairly common. Mean weight loss was 38 kg (±14 kg), equivalent to 60% of excess weight, achieved within 1 year of operation, after which no further significant gain or loss of weight occurred. Conclusions:The Magenstrasse and Mill procedure is the simplest and most physiological gastroplasty yet described. Many of the drawbacks of vertical banded gastroplasty, adjustable banding and gastric bypass are avoided. It is safe, has few side-effects and leads to major and durable weight losses, similar to those produced by other types of gastroplasty.     

Laparoscopic Gastric Rebanding for Slippage with Pouch Dilation: Results on 29 Consecutive Patients

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) slippage with pouch dilation is one the most serious long-term complications and requires reoperation in most cases. It is still controversial whether banding should be offered again or a different procedure should be chosen. We report the results of synchronous de-rebanding on a prospective series of patients treated at our institution for slippage with pouch dilation. METHODS: From January 2000 to May 2007, 29 consecutive patients underwent laparoscopic de-rebanding for slippage with pouch dilation. The mean age at primary operation was 38.9 +/- 8.2 years and the mean BMI was 46.4 +/- 8 kg/m(2). Twenty-eight had previous LAGB, while one had previous open gastric banding, the perigastric technique being used at that time. All the redo procedures were successfully carried out under laparoscopy, via the pars flaccida technique, and all the patients were followed-up according to the usual schedule. RESULTS: The mean time from the original LAGB was 45.3 +/- 30.3 months, and the mean follow-up after rebanding was 26.9 +/- 20.6 months. At rebanding, the mean BMI was 34.3 +/- 7.6, percent excess weight loss (%EWL) 54.5 +/- 31, and percent excess BMI loss (%EBL) 58.3 +/- 33, respectively. After 1 year, BMI was 36.3 +/- 7.9, %EWL 40.8 +/- 30.5, and %EBL 43.9 +/- 32.7, respectively. After 2 years, BMI was 37.13 +/- 7.4, %EWL 36.9 +/- 29.4, and %EBL 39.6 +/- 31.6, respectively, and after 3 years, BMI was 33.5 +/- 5.6, %EWL 51.9 +/- 24.3, and %EBL 55.7 +/- 25.7, respectively. One patient had re-rebanding after 6 months for a new slippage, two had band removal with refusal to switch to another procedure, one had biliopancreatic diversion for slippage recurrence, and one underwent sleeve gastrectomy for insufficient weight loss after 6 months. CONCLUSIONS: Although this is a limited series, our results show that good outcomes can be expected after rebanding in properly assessed patients with slippage and pouch dilation. Larger series and longer follow-up are needed to confirm these findings.     

The Magenstrasse and Mill Procedure can be Combined with a Roux-en-Y Gastric Bypass to Produce Greater and Sustained Weight Loss

Background: The Magenstrasse and Mill operation (M&M) is effective in producing sustained weight loss and reducing obesity-related co-morbidity. It avoids the implantation of foreign material and is a more physiological procedure by maintaining normal gastric emptying. Side-effects are minimal and operative mortality is low. Satisfactory weight loss is seen at 1 year with 60% of excess weight lost. The present study compared weight loss produced by the combination of a Roux-en-Y gastric bypass (RYGBP) with the standard M&M procedure. Methods: Between 1993 and 2001, 118 patients underwent surgery for the treatment of morbid obesity. 70 patients between 1993 and 1998 underwent only a M&M vertical gastric stapling, and 48 patients from 1998 underwent the M&M combined with a RYGBP. Results: Median follow-up for the M&M procedure was 36 months (range 1 to 72) and for the combined M & M and RYGBP was 30 months (range 1 to 48). At all time points following surgery, patients having a RYGBP performed in addition to the standard M&M procedure demonstrated a significantly greater amount of weight lost (P<0.0001, Mann-Whitney U-test) and overall percentage of excess weight lost (P<0.0001, Mann-Whitney U-test). Both groups had a significant reduction in BMI, although this was greater in the group that underwent the combined procedure at 3 years (P<0.001, sample t-test). Conclusions: A more rapid and prolonged weight loss was found when the M&M procedure was performed in combination with a RYGBP. This suggests that this combined procedure may be more beneficial when greater amounts of weight loss are needed in the super-obese.     

Emptying of the intrathoracic stomach using three different pylorus drainage procedures — Results of a comparative study

Patterns of gastric emptying in the vagotomized intrathoracic stomach (used for esophageal replacement) were studied using radioisotope techniques. Following esophagectomy and gastric mobilization, the patients were randomized into three groups: group 1, pyloroplasty; group 2, pyloromyotomy; and group 3, pylorus stretching. A total of 30 patients surviving the operation and who were still alive at least 3 months afterwards were included in this study. Gastric emptying (GE) was evaluated 6–8 weeks after the operation. The mean GE time for liquids was 3.3±2.7, 4.1±3.1, and 5.5 ±4.3 min in the three groups, respectively. The corresponding GE time for solids in the three groups was 9.9±5.1, 10.31± 6.6, and 7.7±3.4 min. No statistical difference was observed in the GE in the three groups even though liquids tend to empty faster than solids. Clinically there was also no significant difference in their ability to tolerate normal meals. When evaluated for clinical evidence of altered GE (effect of vagotomy) there did not appear to be any significant differences between the three groups. It is therefore concluded that all pylorus drainage procedures behave in much the same way. Patients may develop some problems, but these disappear in due course after proper adjustments have been made in both posture and diet.This paper was presented at the 95th Annual Congress of the Japan Surgical Society in Nagoya, Japan, April 10–12, 1995.     

Y-U advancement pyloroplasty.

Heineke in 1886 and von Mikulicz in 1887 independently described the popular method of pyloroplasty by longitudinal incision and transverse closure. In some patients, particularly children, the Heineke-Mikulicz procedure has not always been satisfactory because of inadequate size and distortion of the muscular gastroduodenal funnel. In 1958, Moschel and co-workers reintroduced the concept of the Y-V advancement principle to enlarge the pylorus. This operation has not been widely adopted but has a number of attractive features, including simplicity, safety, and maximal channel size with minimal operating time. The standard Y-V principle has been modified in favor of a broadly based U-shaped pedicle constructed from the presenting surface of the gastric antrum which is advanced into an incision made in the anterior duodenum. This operation has been used in 33 patients, who range in age from 3 weeks to 17 years. They have been variously followed from 6 months to 10 years. The surgical need for pyloroplasty in this group of patients included hiatal hernia with delayed gastric emptying (19 patients); vagotomy for ulcer (7 patients); esophageal substitution (4 patients); vagotomy for reflux esophagitis (2 patients); and, in one instance, revision of an obstructed Heineke-Mikulicz pyloroplasty. Complications have been minimal; gastric drainage has been highly satisfactory. In long-term followup, no ill effect has been seen from the presence of antral mucosa in the proximal duodenum.     

Vagotomy and double pyloroplasty for peptic ulcer.

Seventy patients with peptic ulcers (55 duodenal and 15 gastric) were treated by truncal vagotomy and doulbe pyloroplasty during the past four years. Clinical and experimental data as presented lead us to believe that transecting the pylorus twice produces an incontinent pyloric sphincter and a larger gastric outlet than is found in other methods of pyloroplasty. This decreases gastric stasis and has led to a lower ulcer recurrence rate (1.5%). In addition the untoward postoperative sequelae are minimal. The 70 patients treated (for the most pare consecutive cases) exhibited the usual complications of peptic ulcer disease. Thirty-three had intractable pain, 23 bleeding (15 massive), 13 obstruction, and one acute perforation. There were no operative or postoperative deaths and the only serious postoperative complication was unrelated to the double pyloroplasty. During the followup period four patients have died of unrelated diseases. Of the remaining 66 patients one developed a probable recurrent peptic ulcer which has responded to medical management. Four patients have intermittent dumping, three have mild diarrhea and one has failed to gain weight, Constipation and weight gain are more common complaints. It would appear that vagotomy with double pyloroplasty is a safe and effective operation for peptic ulcers and that further clinical trials are warranted.     

Implantable gastric stimulation to achieve weight loss in patients with a low body mass index

This report describes the authors’ early outcomes with implantable gastric stimulation (IGS) used to achieve weight loss in patients with a low body mass index (BMI). After prescreening of potential candidates with a selection algorithm, 24 patients (21 women and 3 men) with a low BMI (30–34.9) underwent IGS implantation at two centers. The patients had a mean age of 43 years (range, 32–60 years), a mean BMI of 33 (range, 30–36), and a mean weight of 92 kg (range, 80–117 kg). At this writing, 6 months postoperatively, there have been no serious adverse events related to the device. The mean percentage of excess weight loss (EWL) was 5.9%, with three patients explanted because of noncompliance. The mean waist circumference decreased 5.8%, which was significant (p = 0.009). A subset of nine patients (37.5%) had an EWL exceeding 10% (mean, 20.1%). A subset of low BMI patients lost a clinically significant amount of weight with IGS within 6 months. Further study is required for better identification of potential candidates for this novel approach. Presented at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) meeting, Fort Lauderdale, FL, April 2005     

Pyloroplasty versus no drainage in gastric replacement of the esophagus

In a prospective randomized study of pyloroplasty versus no drainage, 200 patients (100 in each group) in whom the whole stomach was used for reconstruction following resection for esophageal carcinoma were studied. Only patients who underwent the Lewis-Tanner operation and who had a normal pylorus were included. There was no morbidity from the pyloroplasty procedure. Thirteen patients without drainage developed symptoms of gastric outlet obstruction, requiring prolonged post-operative parenteral nutrition, and reoperation was required in one patient. Four patients developed pulmonary complications associated with gastric distension, which resulted in fatal aspiration in two patients. Five patients had symptoms of outlet obstruction with eating at the time of their death. Mean and standard deviation of daily gastric aspirate was 161 +/- 88 mL in the pyloroplasty group and 233 +/- 142 mL for the control group (p = 0.23). Gastric emptying test showed mean T1/2 +/- standard deviation of 6.6 +/- 7.5 minutes in the pyloroplasty group and 24.3 +/- 31.5 minutes in the control group (p less than 0.001). More patients in the pyloroplasty group were able to tolerate a solid diet and at normal or increased amounts than were patients in the control group in the early postoperative weeks (p less than 0.01). In addition, control patients were found to have increased symptoms with meals, which were more frequent and of greater severity than symptoms in patients in the pyloroplasty group, even at 6 months after surgery (p less than 0.01). Therefore, we recommend a pyloroplasty for patients in whom the whole stomach is used for reconstruction after esophagectomy.     

Impact of Laparoscopic Adjustable Gastric Banding on Obesity Co-morbidities in the Medium- and Long-Term

Background The authors evaluated the impact of laparoscopic adjustable gastric banding (LAGB) on obesity-associated diseases in a series at 3 to 8 years postoperatively, namely diabetes, pulmonary disease, hypertension and knee joint pain. Methods 145 morbidly obese patients underwent LAGB with mean age 38 years and preoperative BMI 48.5 kg/m2 (range 34–77). Changes in BMI and excess BMI loss (EBL) were evaluated. Results 138 of the 145 patients (95%) were available for full follow-up. At last follow-up, BMI had dropped to 34.0 ± 6.4 SD kg/m², and mean EBL was 61.9 ± 26.1%. Prevalence of obesity-associated disease was significantly reduced: diabetes decreased from 10% to 4%, treatment-requiring pulmonary disease from 15% to 5%, hypertension from 43% to 27%, and knee pain from 47% to 38%. Conclusion Following gastric banding, >75% of patients suffering from obesity-related disease had significant decrease or resolution of their co-morbidities.     

Simple pyloroplasty using a linear stapler in surgery for esophageal cancer

This article describes a simple pyloroplasty procedure using a linear stapler in surgery for esophageal cancer. Simple pyloroplasty was carried out using a linear stapler in a total of 22 patients, whose stomachs were used as esophageal substitutes in the surgery for esophageal cancer. Endoscopy was performed and the pyloric diameter was measured perioperatively. A barium meal study was conducted 1 month after the surgery. Stapling enlarged the diameter of the pylorus by nearly 10 %. Endoscopy revealed a smooth inner surface of the pylorus, enlargement of pyloric channel, and fewer spasms of the pylorus at the 1-month follow-up. Postoperative barium meal studies showed good patency of all of the patients’ gastric outlets. Simple pyloroplasty is a time-saving and non-soiling technique used to perform the drainage of the gastric conduit for resection of esophageal cancer.     

Biliopancreatic Diversion with Transitory Gastric Restriction and Duodenal Bulb Preservation: 88 Patients since 1992

Background: Over 10 years, 88 patients underwent biliopancreatic diversion with transitory gastric restriction (BPD-TGR) as a first choice operation or after gastric restrictive procedures. Methods: From 1992 to 1999, BPD-TGR was performed on 71 patients as a first choice operation (Group 1 – BMI 41.9 ± 6.5). The TGR was achieved by a polydioxanone (PDS) band. The duodenal bulb was maintained to 5 cm distal to the pylorus, constructing an end-to-side antecolic isoperistaltic duodeno-ileal anastomosis. Since 1993, a further 17 patients underwent BPD-TGR as a correction for restrictive procedures (Group 2 – BMI 37.4, range 27.2-61.0). Results: Results in weight loss in Group 1 were similar to those in our previous classical BPD. Percent excess weight loss (%EWL) was 68.0 ± 18.4, 75.9 ± 12.3, and 75.4 ± 12.0 at 1,5 and 10 years respectively. No patient had severe dysproteinemia (only 3% of patients had hypoalbuminemia of 3.0-3.4 g/dl). There was no case of diarrhea or halitosis. Anastomotic ulcers occurred in 2% of the patients. In Group 2, the patients had weight loss already present from the first operation, which continued after BPD-TGR with great variability from patient to patient. %EWL was 35.1 (range 0 to 72.5) and 35.2 (range 18.4 to 43.2) at 1 and 5 years. Conclusions: BPD-TGR appears to be an effective operation with few complications and also a satisfac tory correction for failed gastric restrictive procedures, or even a sequential operation in the super-obese.     

Proximal selective vagotomy with or without pyloroplasty?]

Proximal gastric vagotomy without drainage is the operation of choice for uncomplicated duodenal ulcer. There are few contraindications for PGV as uremia, diabetes, hypertension, age over 65 years and a history of splenectomy. Only in cases of severe pyloric stenosis or bleeding ulcer or perforation in the pyloric area, a pyloroplasty should be added. The Wangensteen pyloroplasty is a safe drainage procedure and especially recommended in case of extensive scarring of the pylorus.     

“No Punch” Technique of Laparoscopic Vertical Banded Gastroplasty for Morbid Obesity

Background: This report describes the technical details and an initial evaluation of laparoscopic vertical gastroplasty modified for morbid obesity. After a surgical experience in 150 patients with open vertical banded gastroplasty (Mason's procedure), it was decided to perform a modified banded vertical gastroplasty. Materials and methods: Six patients were treated by this laparoscopic approach in 1997-1998. All patients were women with a mean age of 28 years (range 20-46). The mean body weight was 128 kg (range 105-146), and the mean BMI was 42.7 kg/m2 (range 35.6-53.0). Four or five 10- or 12-mm trocars were used. For all the dissection we used atraumatic ultracision (harmonic scalpel). In this procedure the technique of laparoscopic gastroplasty is performed without a circular gastric window. During the operation, 3 omental openings were made and the vertical staple-line was constructed by using a 30-mm 3-row linear stapler twice, establishing the gastric pouch. The outflow stoma was reinforced by a Gore-Tex band and calibrated to have an internal diameter of 10-15 mm. The band was sutured to itself. Results: There were no deaths or complications. Operating time was 200 min (150-240). The nasogastric tube was removed at 1-2 days. The postoperative course was characterized by normal respiratory function and minimal pain in all cases. Patients were discharged 5-6 days after operation. Conclusions: Our technique excluded the circular gastric window (i.e., “no-punch”) technique in the development of an effective and simple laparoscopic procedure to treat morbid obesity.     

A pilot study of botulinum toxin injection for the treatment of delayed gastric emptying following esophagectomy

Objective Esophagectomy may lead to impairment in gastric emptying, unless a pyloroplasty or pyloromyotomy is performed. These procedures may be technically challenging during minimally invasive esophagectomy, and they are associated with a small but definable morbidity, such as leakage and dumping syndrome. We sought to determine the results of our early experience with injecting the pylorus with botulinum toxin instead of conventional pyloric drainage. Methods Fifteen patients who had undergone esophagectomy and injection of the pylorus with botulinum toxin were identified. Twelve patients had undergone botulinum toxin injection at the time of minimally invasive esophagectomy, and the remaining three had been treated endoscopically after surgery. The latter three patients had undergone esophagectomy with either no pyloric drainage (n = 2) or an inadequate pyloromyotomy (n = 1), and they presented in the postoperative period with delayed gastric emptying. The adequacy of emptying after injection was assessed by the patients’ ability to tolerate a regular diet, a barium swallow, and a nuclear gastric emptying study. Results No patient injected with botulinum toxin during esophagectomy developed delayed gastric emptying or aspiration pneumonia in the perioperative period. Eight of these patients underwent a nuclear emptying scan at a median of 4.2 months after surgery, which showed a mean emptying half-life of 100 min. With a median follow-up of 5.3 months, one patient (8%) required reintervention for symptoms of gastric stasis, presumably after the effect of the toxin subsided. All three patients injected postoperatively demonstrated an improvement in symptoms of gastric outlet obstruction and were able to resume a regular diet. Conclusions Injection of the pylorus with botulinum toxin can be performed safely in patients undergoing esophagectomy. Longer-term studies are needed to clarify the efficacy and durability of this technique compared to the accepted procedures of pyloromyotomy or pyloroplasty. Presented at the 2006 SAGES Postgraduate Course and Scientific Session, Dallas, Texas An erratum to this article can be found at     

Laparoscopic Sleeve Gastrectomy — Influence of Sleeve Size and Resected Gastric Volume

Background Although the efficacy of laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients with a BMI of < 50 kg/m², the incidence of weight gain by change of eating behaviors, and gastric dilatation following LSG have not been investigated thus far, LSG is becoming more common as a single-stage operation for the treatment morbid obesity. Methods This is a prospective study of the initial 120 patients who underwent isolated LSG. Initially, the LSG was performed without a calibration tube and resulted in high sleeve volumes (group 1: n = 25). In group 2 (n = 32), a calibration tube of 44 Fr and in group 3 (n = 63) a calibration tube of 32 Fr were used. The study group consists of 101 patients with high BMI who were scheduled for a two-step LBPD-DS, but rejected the second step after 1 year. Study endpoints include estimated sleeve volume, volume of removed stomach, operative time, complication rates, length of hospital stay, changes in co-morbidity, percentage of excess BMI loss (%EBL) and changes in BMI (kg/m²). Results All 3 groups were comparable regarding age, gender, and co-morbidities. There was no hospital mortality, but there was one case of late mortality (0.8%). 2 early leaks (1.7%) were seen. % excess BMI loss was significantly higher for patients who underwent LSG with tube calibrations. LSG with large sleeve volume showed a slight weight gain during 5 years of observation. A total of 16 patients (13.3%) underwent a second stage procedure within a period of 5 years (2 redo-sleeves, 7 LBPD-DS, 3 LRYGBP). Conclusion Early weight loss results were not different between the groups, but after 2 years the more restrictive LSG (groups 2, 3) results were significantly better than in patients without calibration. A removed gastric volume of < 500 cc seems to be a predictor of failure in treatment or early weight regain. A statistically significant improved health status and quality of life were registered for all groups. The general introduction of LSG as a one-stage restrictive procedure in the bariatric field can be considered only if the procedure is standardized and long-term results are available.     

New Approach in Surgical Treatment of Morbid Obesity: Laparoscopic Gastric Banding

Background: gastric banding has been performed for morbid obesity, with the last nine patients having a laparoscopic approach. Materials: forty-five patients who had undergone primary operations for morbid obesity between 1986 and 1993 were selected for retrospective analysis. All patients had undergone gastric banding. Average pre-operative BMI was 50.9 (kg m⁻²) and average pre-operative weight was 135.1 kg. Results: the 3-year mean post-operative BMI reached 28.7 and the 3-year mean post-operative weight loss was 55.7 kg. Blood pressure significantly decreased from the mean 151/96 mmHg to 132/90 mmHg at 1-year follow-up. There were no significant changes noted in the levels of RBC, electrolytes and transaminase. There were post-operative wound-healing complications in 18.1% of the patients, wound discharge in 8.8% and incisional hernia in 8.8% of the patients. In 1993 we commenced laparoscopic gastric banding which enabled us to shorten the hospital stay and decrease post-operative complications. Conclusion: we are achieving the same good weight-loss results with the laparoscopic technique as after ‘open’ laparotomy gastric banding.     

Pyloroplasty in infancy and childhood

Twenty-nine children under 18 years of age underwent pyloroplasty alone or together with other abdominal operations during a 6-year period. The 21 males and 8 females ranged in age from 2 weeks to 17 years (mean, 54 months). Peptic ulcer disease was the indication for operation in only 6 patients, whereas 16 patients underwent pyloroplasty for functional or mechanical gastric outlet obstruction; 8 had the antral dysmotility syndrome. Other indications included colon interposition in five patients and gastric resection and esophagogastric devascularization in one patient each. Only five patients had concomitant vagotomy. Ten other patients with antral dysmotility syndrome were successfully managed medically. Follow-up ranged from 2 months to 6 years (mean, 30 months). Excellent catch-up weight gain occurred in over 90% of children with functional or mechanical gastric outlet obstruction, with the best results obtained in children with antral dysmotility syndrome. One patient had transitory dumping symptoms following colon interposition with pyloroplasty which remitted with diet changes. Two patients eventually died of the underlying disease (familial dysautonomia, gastric cancer). There were two major complications, respiratory arrest and wound dehiscence, each occurring following emergency operations for peptic ulcer disease. Pyloroplasty was effective in improving gastric emptying and produced minimal morbidity even in the absence of vagotomy. The indications for pyloroplasty in children are different than for adults.     

IS PYLOROPLASTY NECESSARY FOLLOWING INTRATHORACIC TRANSPOSITION OF STOMACH? RESULTS OF A PROSPECTlVE CLINICAL STUDY

Twenty four patients underwent oesophagectomy for oesophageal cancer. The oesophagogastric anastomosis was performed in the neck in all patients. Following oesophagectomy and gastric mobilization patients were randomly selected into pyloroplasty and no pyloroplasty groups. Pre and postoperative gastric emptying of these patients evaluated by radioisotope technique were then compared. The results suggest significantly delayed postoperative gastric emptying in both the groups though it was less pronounced in the pyloroplasty group. All patients were then carefully followed until death (period varying between 6 months and 4 years) for ill effects of delayed gastric emptying which were present in some patients of both the groups. It was thus concluded that emptying of thoracic stomach is delayed and pyloroplasty fails to improve it completely. Postoperatively patients behave much the same way with or without pyloroplasty.     

Laparoscopic gastric bypass performed with the Da Vinci Intuitive Robotic System: preliminary experience

Background This study aimed to analyze retrospectively the authors’ preliminary experience using the Da Vinci Intuitive Robotic System for gastric bypass in managing morbid obesity, and to determine its efficacy and safety in relation to other standardized laparoscopic surgical techniques. Methods From October 2000 to March 2004 the authors performed 146 laparoscopic gastric bypasses, 17 of which were robot assisted using the Da Vinci Intuitive Robotic System. The last patients were 7 men and 10 women with a mean age of 44 years. The mean weight was 139 kg, and the mean body mass index (BMI) was 49.8 kg/m² at first postoperative recovery. The mean excess body weight (EBW) was 131%. Follow-up assessment, performed at months 1, 3, 6, and 12, then yearly thereafter, included evaluation of the variations in BMI and the percentage of excess body weight loss (EBWL%). All the patients were informed of the risks inherent with each surgical procedure as well as the potential benefits. Results The mean operative time was 201 min (range, 90–300 min). No intraoperative complications and no conversion occurred in this series. The mean hospital stay was 9 days (range, 6–18 days). The patients in this series experienced a normal postoperative course without anastomotic complications. The mortality rate was zero. No robot-related complications were noted. The analysis of follow-up assessment at months 1, 3, 6, and 12 showed a progressive decrease in BMI and an increment of EBWL%. Conclusions The authors’ early experience with robotic surgery suggests that it is safe and could be an effective alternative to conventional laparoscopic surgery. The authors believe that robotic surgery, with its ability to restore the hand–eye coordination and three-dimensional view lost in laparoscopic surgery, could allow complex procedures to be performed with greater precision and better results.