To assess the intraoperative and postoperative safety and efficacy of robotic-assisted sleeve gastrectomy combined with fundoplication and hiatal hernia repair (SGFD+HHR).

This single-center retrospective cohort study included 76 patients with obesity and hiatal hernia who underwent either robotic-assisted or laparoscopic SGFD+HHR at the People's Hospital of Xinjiang Uygur Autonomous Region between January 2020 and July 2024. The patients were divided into a laparoscopic group (n=51) and a robotic group (n=25) based on the surgical approach. Perioperative parameters, postoperative weight loss efficacy, complication rates, Gastroesophageal Reflux Disease Questionnaire (GerdQ) scores, and reflux improvement were compared between the two groups.

There were no statistically significant differences between the two groups in baseline characteristics, operative duration, time to meeting discharge criteria, body weight and body mass index at baseline and 6 and 12 months postoperatively, percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL) at 6 and 12 months postoperatively, the incidence of early and long-term postoperative complications, GerdQ score, or reflux improvement at 12 months postoperatively (all P>0.05). However, the robotic group had less intraoperative blood loss than the laparoscopic group (Z=-3.913, P<0.001). In both groups, GerdQ scores at 12 months postoperatively were significantly lower than baseline scores (Z=-3.650 and -3.611, respectively; both P<0.001).

For patients with obesity and hiatal hernia, both robotic-assisted and laparoscopic SGFD+HHR achieved satisfactory weight loss and anti-reflux outcomes. No significant differences were observed between the two approaches in postoperative weight loss efficacy or complication rates, whereas robotic-assisted surgery was associated with reduced intraoperative blood loss.