Robotic-assisted Versus Laparoscopic Redo Antireflux Surgery in Children: A Cost-Effectiveness Study

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.