Robotic-assisted Proctosigmoidectomy Versus Laparoscopic-assisted Soave Pull-through for Hirschsprung Disease

Objective: To compare the surgical outcomes of robotic-assisted proctosigmoidectomy (RAP) and laparoscopic-assisted Soave pull-through (LAP) for children with Hirschsprung disease (HD). Background: LAP and RAP have been developed for minimally invasive pull-through of HD, but the clinical benefits of robotic-assisted versus laparoscopic-assisted approaches have yet to be proven in a multicenter prospective study. Methods: This study was a prospective multicenter clinical trial conducted on children with rectosigmoid/descending HD from July 2015 to June 2022, with registration in the Chinese Clinical Trial Registry (ChiCTR2000035220). The primary outcome was the medium-term functional outcomes in children aged ≥4 years based on bowel functional scores, which were assessed and compared between LAP and RAP. Results: A total of 328 consecutive patients (RAP = 165, LAP = 163) were approached who were considered eligible for elective minimally invasive endorectal pull-through, and 219 patients aged ≥4 years of age completed follow-up (RAP = 109, LAP = 110). The transanal dissection length and anal traction time were significantly shorter in RAP than those in LAP (0.40 vs 3.70 cm, P < 0.001; 45 vs 62 min, P < 0.001). The RAP group had a significantly lower urinary retention rate (0% vs 5.52%, P = 0.006), whereas other short-term results between the two groups were not significantly different. The medium-term overall bowel function scores were comparable between the two groups; however, among the subgroup of children aged ≤3 months at surgery, the RAP group had better anal canal resting pressure at 1 year postoperatively and amounted to better annual postoperative fecal continence scores at 4 to 7 years old postoperatively (all P < 0.05). Conclusions: RAP and LAP should have similar medium-term bowel functional outcomes in children with HD, but RAP may be associated with a slight functional benefit in infants operated on below age 3 months, requiring further investigation in larger case cohorts.