Redo antireflux surgery: a comparative evaluation of laparoscopic and robot-assisted techniques

Objective. To compare outcomes of redo laparoscopic and robot-assisted surgeries at the esophagogastric junction in patients with prior antireflux procedures. Material and methods. Between 2016 and 2024, 30 patients underwent redo antireflux surgery at the Loginov Moscow Clinical Scientific and Practical Center. Seventeen patients received robot-assisted surgery using the Da Vinci system (main group), while 13 underwent conventional laparoscopic procedures (comparison group). Initial surgeries included Nissen fundoplication (22 cases), Toupet fundoplication (3 cases), and the A.F. Chernousov technique (5 cases). Redo procedures included Toupet fundoplication (11 cases), the Chernousov method (16 cases), posterior cruroplasty with gastropexy (1 case), proximal gastrectomy with double-tract reconstruction (1 case), and Kanashin-type gastroplication combined with Toupet fundoplication (1 case). Results. Median operative time was 180 (105–305) minutes for robotic and 200 (130—340) minutes for laparoscopic surgeries; proximal gastrectomy required 300 minutes. Average intraoperative blood loss was 25 (20—50) mL in the robotic group and 20 (5—70) mL in the laparoscopic group. Median hospital stay was 5 (1—16) days in the robotic group and 6 (2—11) days in the laparoscopic group. No deaths occurred. Conclusion. Redo surgery at the esophagogastric junction using minimally invasive techniques is safe and effective for patients with complicated gastroesophageal reflux disease. Robot-assisted surgery is technically comparable to laparoscopy, with low complication rates and slightly shorter hospitalization durations.