Robotic-assisted versus laparoscopic esophageal hiatal hernia and anti-reflux surgery: A comprehensive systematic review and meta-analysis.

backgroundThe comparison between robotic-assisted (RS) and laparoscopic anti-reflux surgery (LS) remains clinically relevant due to widespread adoption of robotic techniques without clear evidence of superior outcomes. This study aims to evaluate both approaches in terms of efficacy, safety, and cost.

methodsAdhering to PRISMA guidelines, we systematically searched in Medline, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang Data Knowledge Service Platform (2000-2025) for randomized controlled trials (RCTs) and observational studies comparing RS and LS in adults. Pooled analyzes utilized random- or fixed-effects meta-analysis models. Meta-regression, cumulative meta-analysis, and subgroup analyzes were conducted to enhance conclusion precision. Sensitivity analyzes assessed result robustness.

resultsThe systematic review included 38 studies (5 RCTs and 33 cohort studies) with a pooled population of 550,175 patients. For the primary outcome, no significant difference was observed in overall postoperative complications between RS and LS (RR = 0.85, 95% CI: 0.60-1.20). Among secondary outcomes, RS was associated with longer overall operative times (WMD = 19.81 min, 95% CI: 11.15-28.47 min); however, when only skin-to-skin operative time was analyzed, the difference was not statistically significant (WMD = 11.90 min, 95% CI: -7.75 to 31.55 min). RS demonstrated higher costs (WMD = $2,958.97, 95% CI: $1820.74-4,097.19) versus LS. No statistically significant differences were observed in blood loss, length of stay, intraoperative complications, recurrence, reoperation, or postoperative anti-reflux medication requirements. Cumulative meta-analysis demonstrated stable and consistent differences over time, indicating the early emergence of robust evidence.

conclusionRS showed comparable outcomes to LS in complications, blood loss, recurrence, reoperation, and postoperative medication requirements. RS was associated with higher costs compared to LS. Although overall operative time was longer with RS, subgroup analysis revealed no statistically significant difference in skin-to-skin surgical time between the two approaches. RS had higher costs. Comprehensive evaluations indicate that RS and LS yield analogous outcomes in terms of safety and efficacy for GERD. However, RS is linked to increased financial expenditure.