Safety of robotic-assisted surgery in redo fundoplication: a systematic review and meta-analysis

Redo fundoplication is technically challenging and associated with higher complication rates compared with primary procedures. Robotic platforms may offer technical advantages in reoperative foregut surgery; however, comparative outcomes with laparoscopy remain unclear. This meta-analysis aimed to compare perioperative outcomes between robotic and laparoscopic redo fundoplication. A systematic review and meta-analysis was conducted by searching five databases up to July 2026. Primary outcome was intraoperative complications, including leaks, gastric, esophageal, and bowel injuries. Secondary outcomes were postoperative complications (POC), operative time (OT) and length of stay (LOS). The random-effects model was used to calculate the pooled Odds Ratios (OR) and mean difference (MD) with 95% confidence intervals (CI). Heterogeneity was assessed using I² statistics. Of 269 studies screened, 4 cohort studies comprising 257 patients were included. Robotic cases accounted for 49% (n = 126). There was no difference between groups in terms of sex, age and preoperative BMI. Robotic cases had longer OT (MD = 26.36 min, p = 0.03) but shorter LOS (MD = - 0.16 days, p = 0.55), with a lower risk of intraoperative complications (6.3% vs. 9.1%; OR = 0.57, 95% CI = 0.22-1.47, I²: 0%). There were no differences in POC rates. In this meta-analysis, robotic redo fundoplication was as safe as the laparoscopic approach, in terms of intra- and postoperative complications. Higher-quality prospective evidence is needed before firm conclusions can be drawn.