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

• Published in: The international journal of medical robotics + computer assisted surgery Vol. 19; no. 6; p. e2541
• Main Authors: Delgado-Miguel, Carlos, Camps, Juan I
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-12-2023
• Subjects: Children; Economic impact; Laparoscopy; Robotic surgery; Robotics; Surgery; robotics; cost-effectiveness; children; redo fundoplication; gastroesophageal reflux disease
• ISSN: 1478-5951; 1478-596X
• DOI: 10.1002/rcs.2541

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 ± 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).
Robotic-assisted redo antireflux surgery may offer several benefits over the laparoscopic approach. Prospective studies are still needed.