Postoperative outcomes of robotic-assisted vs. laparoscopic pull-through surgery in pediatric Hirschsprung's disease: a systematic review and meta-analysis.

Hirschsprung's disease (HSCR) is a congenital bowel disorder caused by absent enteric ganglion cells, often in neonates with intestinal obstruction. Minimally invasive surgical resection is the standard treatment. Robotic-assisted pull-through surgery (RAS) offers improved precision, but comparative data with laparoscopic-assisted surgery (LAS) is limited. This systematic review and meta-analysis evaluated postoperative outcomes between RAS and LAS in pediatric HSCR. Literature search was performed in PubMed/MEDLINE, Web of Science, Scopus, EMBASE, CINAHL, and Cochrane Library, following PRISMA guidelines. Random-effects meta-analysis with 95% confidence interval (CI) was conducted. Protocol was preregistered on PROSPERO (CRD420251033648). Four studies involving 291 pediatric patients (124 RAS, 167 LAS) were included. RAS demonstrated significantly lower blood loss (MD = - 2.66; 95% CI - 4.54 to - 0.80; p < 0.01) and higher hospitalization expenses (MD = 44,922.20; 95% CI 43,592.28-46,252.12; p < 0.01). LAS presented shorter postoperative feed times (MD = 1.00; 95% CI 0.16-1.84; p = 0.02). No significant differences were observed in other postoperative outcomes. RAS appears to be a safe alternative to LAS in pediatric HSCR. However, no definitive clinical advantage of RAS is confirmed. Further studies are warranted to clarify its role in pediatric colorectal surgery.