Robotic redo surgery in hirschsprung disease: results, considerations and perspectives

Redo surgery in Hirschsprung disease(HSCR) can be very challenging. Historically, open surgery has been regarded as the preferred approach for complex redo procedures. Aim of the study is to present a single-center experience with Robotic Redo surgery in HSCR.

A retrospective cohort study was conducted. Charts of all HSCR patients previously subjected to pull-trough(P-T) that underwent Robotic Redo Surgery(Redo P-T, Redundant Rectal Pouch Excision and Miles-like procedure) in our Center between 2017 and 2025 were reviewed. The Primary objective is to state feasibility, safeness and effectiveness of Robotic Redo Surgery in HSCR. A secondary objective is to compare safety and effectiveness of Robotic Redo P-T with Laparoscopic and Open Redo P-T.

16 Robotic Redo P-T, 3 Redundant Rectal Pouch Excisions and 2 Miles-like procedures were performed. Overall, no intraoperative complications were registered and post-operative major complication rate (Clavien Madadi > = III) was acceptable (13% of Robotic Redo P-T procedures, none in the Rectal Pouch Excision and Miles-like groups). Continence was optimal for the latter two procedures and, in accordance with the literature, suboptimal for Redo P-T(excellent-good in 64% of patients). When comparing Robotic Redo P-T(n:16) VS Laparoscopic(n:10) and VS Open Redo P-T(n:5), intra-operative complications were respectively 0, 10% and 40%(p:0.40, p:0.05) and post-operative complications were 19%, 40% and 40%(p:0.40, p:0.50). Continence was comparable for robotic and laparoscopy.

Robotic redo surgery in HSCR is feasible, safe and effective. Robotic surgery qualities can be particularly advantageous in case of potential challenging pelvic dissection. More data are required to confirm our results.