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

Abstract

IntroductionRobotic‐assisted redo fundoplication has some advantages compared to the laparoscopic approach in adults, although to date there are no studies in children.MethodsA 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.ResultsA 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 ± 69 mL; p < 0.021), shorter surgery time (135 ± 39 vs. 179 ± 68 min; p = 0.009) and shorter length of hospital stay (median 3 days [2–4] vs. 5 days [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 (25 800$ vs. 45 500$; p = 0.012).ConclusionRobotic‐assisted redo antireflux surgery may offer several benefits over the laparoscopic approach. Prospective studies are still needed.