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Robotic-assisted versus laparoscopic redo antireflux surgery in children: A cost-effectiveness study
Carlos Delgado-Miguel1,2, Juan I Camps1
1Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, USA.
Insights
Robotic-assisted redo fundoplication in children showed reduced blood loss, shorter surgery, and hospital stays compared to laparoscopic methods. This approach may improve symptom outcomes and lower costs, warranting further investigation.
Area of Science:
- Pediatric surgery
- Gastrointestinal surgery
- Minimally invasive surgery
Background:
- Redo antireflux surgery is complex in children.
- Robotic-assisted surgery offers potential advantages over laparoscopy in adults.
- Limited data exists on robotic-assisted redo fundoplication in pediatric populations.
Purpose of the Study:
- To compare the outcomes of robotic-assisted redo fundoplication (RAF) versus laparoscopic redo-fundoplication (LAF) in children.
- To evaluate intraoperative, postoperative, and economic differences between the two surgical approaches.
Main Methods:
- Retrospective case-control study of pediatric patients undergoing redo antireflux surgery (2004-2020).
- Comparison of two groups: LAF (n=10) and RAF (n=14).
- Analysis of demographic, clinical, intraoperative, postoperative, and economic data.
Main Results:
- The RAF group demonstrated significantly lower intraoperative blood loss (p<0.021) and shorter operative times (p=0.009).
- Patients in the RAF group experienced a shorter length of hospital stay (p=0.002) and lower overall costs (p=0.012).
- A trend towards higher symptom improvement was observed in the RAF group (85.7% vs. 60%).
Conclusions:
- Robotic-assisted redo antireflux surgery appears to offer significant benefits in pediatric patients compared to the laparoscopic approach.
- The findings suggest potential improvements in surgical efficiency, recovery, and cost-effectiveness.
- Further prospective studies are recommended to validate these preliminary findings.
Introduction:
Robotic-assisted redo fundoplication has some advantages compared to the laparoscopic approach in adults, although to date there are no studies in children.
Methods:
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.
Results:
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).
Conclusion:
Robotic-assisted redo antireflux surgery may offer several benefits over the laparoscopic approach. Prospective studies are still needed.
