Robotic versus laparoscopic anti-reflux and hiatal surgery in a uk benign upper gi unit: perioperative outcomes in a four-year observational study

Abstract Robotic fundoplication is rapidly expanding across the UK, however, robust comparative data from routine benign upper gastrointestinal (UGI) practice remain limited. This study compares perioperative outcomes of robotic and laparoscopic fundoplication within a UK benign UGI unit. This retrospective observational study included consecutive adults undergoing elective laparoscopic or robotic anti-reflux or hiatal surgery between February 2022 and January 2026. The primary outcome was total operative time. Secondary outcomes included length of stay, same-day discharge, complications, 30-day readmission, 30-day return to theatre, subsequent redofundoplication and early clinically recorded recurrence. One hundred patients were included: 57 robotic and 43 laparoscopic. Revisional surgery was more frequent robotically (33.3% versus 11.6%; p = 0.006). Overall, robotic procedures had shorter median operative times (88 versus 120 min; p = 0.017) and higher same-day discharge rates (63.2% versus 27.9%). After excluding the highest-volume robotic surgeon, median robotic operative time remained 27 min shorter than laparoscopy (93 versus 120 min), although the difference was no longer statistically significant ( p = 0.16). Among 76 primary operations, robotics was associated with shorter unadjusted operative time (77 versus 120 min; p < 0.001), shorter length of stay (0 versus 1 day; p = 0.003) and higher same-day discharge (60.5% versus 23.7%; OR 4.94, 95% CI 1.83–13.31; p = 0.002). Following covariate adjustment, operative time remained an estimated 11% shorter robotically, although the confidence interval included no difference (time ratio 0.89, 95% CI 0.72–1.09; p = 0.250). The association with same-day discharge persisted after adjustment (OR 5.02, 95% CI 1.09–23.00; p = 0.038). Robotic anti-reflux and hiatal surgery was successfully integrated into an established benign UGI service, including for a substantial revisional workload. Favourable operative times and same-day discharge rates demonstrate the potential for efficient service delivery, although the respective contributions of platform, surgeon expertise, case selection and treatment era cannot be separated. These findings demonstrate feasibility and support further prospective evaluation of its comparative clinical and economic value.