A network meta-analysis comparing laparoscopic, open and robotic restorative proctocolectomy with ileal pouch-anal...

Despite multiple attempts to compare open and laparoscopic approaches, data for robotic IPAA are still limited. The relative merit of the three approaches regarding safety and efficacy is still not known. Therefore, we conducted this study to provide up-to-date data regarding the safety and perioperative efficacy of laparoscopic, open and robotic approaches in restorative proctocolectomy with ileal pouch-anal anastomosis [IPAA]. This network meta-analysis [NMA] was based on the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA-NMA guidelines. The primary endpoint of our study was the overall complication rate. The last search date was 24/10/2025. A random effects (RE) multivariate network meta-analysis under a Bayesian framework was utilized. Ranking was based on the surface under the cumulative ranking [SUCRA] values. Overall, 63 studies and 11,699 patients were included. Regarding the primary outcome, laparoscopy had a significantly lower risk of overall complications compared to robotics (OR: 0.65, 95%CI [0.44, 0.97]) and ranked first (82.7%). Robotics decreased the risk of open conversion (OR: 0.12, 95%CI [0.01, 0.73]), whereas open was associated with lower risk of small bowel obstruction OR: 0.76, 95%CI [0.6, 0.96]) and readmission over laparoscopy (OR: 0.66, 95%CI [0.42, 0.99]). Both minimal invasive techniques required significantly longer operative time and reduced blood loss and LOS compared to open. Both minimal invasive approaches displayed superiority over open IPAA in various safety and efficacy outcomes.