Early nationwide experience with robotic versus open lateral pancreaticojejunostomy for symptomatic wide-duct chronic pancreatitis

Abstract Background Lateral pancreaticojejunostomy (LPJ) is the treatment of choice in patients with symptomatic wide-duct chronic pancreatitis and a normal-size pancreatic head. Adequate pain control in the first days after LPJ via laparotomy is often challenging in these patients due to opioid tolerance resulting from chronic opioid use. Although a robotic approach may improve short-term outcome, comparative multicenter data on robotic versus open LPJ are lacking. Methods This nationwide multicenter retrospective cohort study included consecutive adults who underwent robotic or open LPJ for symptomatic wide-duct chronic pancreatitis in the Netherlands (2010–2025). Primary outcomes were hospital stay and major complications (Clavien–Dindo grade III or higher). Results Overall, 133 patients undergoing LPJ were included, of whom 36 (27%) robotic and 97 (73%) open LPJ. The robotic LPJ conversion rate was 0% (0/36). In the overall cohort, 90-day mortality was 0% (0/133) and median hospital stay was 2 days shorter after robotic LPJ (5 [IQR, 4–7] vs 7 [6–10] days; P < 0.001) compared with open LPJ, while the rate of major complications did not differ significantly between groups (36.1% [13/36] vs 26.8% [26/97]; P = 0.405). Blood loss was less with robotic LPJ (100 [IQR, 50–100] vs 300 [125–500] mL; P < 0.001), whereas operative time was comparable (275 [IQR 180–330] vs 232 [188–276] minutes; P = 0.210), and the rate of postoperative pancreatic fistula (POPF) grade B/C was higher (22.2% [8/36] vs 7.2% [7/97]; P = 0.034). The main findings of the overall cohort remained broadly consistent after propensity score matching. Conclusions In this early nationwide experience, robotic LPJ was associated with shorter hospital stay compared with open LPJ. Although operative time and major complications did not differ significantly between groups, POPF occurred more frequently after robotic LPJ. The potential benefits of robotic LPJ and the possible learning curve effect should be further assessed in randomized trials in experienced centers.