Robot-assisted versus conventional laparoscopic antireflux surgery: a retrospective cohort analysis of perioperative and medium-term outcomes.

Gastroesophageal reflux disease (GERD) is a prevalent condition often associated with hiatal hernia (HH). While conventional laparoscopic anti-reflux surgery (CLAS) remains the gold standard for refractory GERD, robotic-assisted anti-reflux surgery (RAAS) has emerged as a promising alternative, offering enhanced precision and ergonomics. This study compares perioperative outcomes and mid-term symptom resolution between RAAS and CLAS. A retrospective cohort analysis included 91 patients undergoing primary anti-reflux surgery (RAAS n = 31, CLAS n = 60) between April 2022 and April 2024. Patients had confirmed GERD unresponsive to proton pump inhibitors (PPI), excluding giant HH or prior surgery. Standardized preoperative evaluation and surgical protocols were followed. Perioperative metrics (operative time, complications) and symptomatic outcomes at 12-month follow-up (GERDQ scores, symptom resolution, reoperations, PPI use, endoscopic/ultrasound findings) were compared. Demographic and baseline characteristics were comparable between groups. RAAS had significantly longer total operative time (158.8 vs. 146.4 min, p = 0.02) and docking/setup time (21.2 vs. 11.5 min, p = 0.02), primarily due to the initial dissection phase. Intraoperative complication rates (3.2% vs. 5.0%, p = 0.65), postoperative stay (3.32 vs. 3.75 days, p = 0.40), and 30-day mortality (0% both) were similar. At median follow-up, rates of complete symptom resolution (80.6% vs. 75.0%, p = 0.55), residual symptoms (e.g., dysphagia: 6.5% vs. 15.0%, p = 0.40), postoperative PPI use (16.1% vs. 8.3%, p = 0.43), objective reflux on imaging (7.7% both), and reoperation rates (3.2% vs. 5.0%, p = 0.70) showed no significant differences. RAAS achieves perioperative safety and medium-term symptomatic outcomes comparable to CLAS. While technically feasible, RAAS requires longer operative times initially, with a notable learning curve for docking. No significant clinical superiority of RAAS was demonstrated in this cohort. Further randomized trials evaluating long-term durability and cost-effectiveness are warranted.