Does robotics add value in Hartmann's reversal? A PRISMA-based systematic review and meta-analysis of perioperative...

Reversal of Hartmann's procedure is technically demanding and occasionally performed via open surgery, which is associated with substantial morbidity. Minimally invasive approaches have expanded, yet comparative evidence between robotic and laparoscopic reversal remains limited. We conducted a systematic review and meta-analysis to compare perioperative outcomes of both approaches.

Databases were searched through 20 July 2026. Studies reporting outcomes after laparoscopic and/or robotic Hartmann's reversal were included. Random-effects meta-analyses were performed with preplanned subgroup comparisons (robotic versus laparoscopic). Pooled estimates were reported with 95% confidence intervals; heterogeneity was assessed using I². Evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Sixty-five studies comprising >10,000 patients were included. Operative time was significantly longer with robotics (274.6 versus 176.04 min; P = 0.018). Robotic studies reported lower pooled surgical site infection rates (4% versus 6%; P = 0.02) and shorter length of hospital stay (4.2 versus 8.0 days; P < 0.001). Conversion to open surgery pooled rate was lower in robotic studies (7% versus 14%), yet the subgroup difference did not reach statistical significance.

Robotic Hartmann's reversal was associated with longer operative time, while pooled analyses showed lower surgical site infection rates and shorter hospital stay than pooled laparoscopic reversal. However, the current robotic evidence base remains limited and is largely derived from indirect comparisons and pooled single-arm analyses. Higher-quality comparative data are needed to define patient selection, cost, and benefit.