Robotic-assisted versus laparoscopic redo antireflux surgery in children: A cost-effectiveness study.

Abstract

Robotic-assisted redo fundoplication has some advantages compared to the laparoscopic approach in adults, although to date there are no studies in children. A retrospective case-control study was performed among consecutive children who underwent redo antireflux surgery between 2004 and 2020, divided into two groups: LAF group (laparoscopic redo-fundoplication) and RAF group (robotic-assisted redo-fundoplication). Demographics, clinical, intraoperative, postoperative and economic data were compared. A total of 24 patients were included (10 LAF group; 14 RAF group) without demographic or clinical differences. The RAF group presented lower intraoperative blood loss (52±19 vs. 145±69mL; p<0.021), shorter surgery time (135±39 vs. 179±68min; p=0.009) and shorter length of hospital stay (median 3days [2-4] vs. 5days [3-7]; p=0.002). The RAF group presented a higher rate of symptom improvement (85.7% vs. 60%; p=0.192) and lower overall associated economic costs (25800$ vs. 45500$; p=0.012). Robotic-assisted redo antireflux surgery may offer several benefits over the laparoscopic approach. Prospective studies are still needed.