{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T23:05:09Z","timestamp":1790118309939,"version":"4.0.1"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In Hirschsprung disease (HD), the laparoscopic-assisted Yancey\u2013Soave (LAYaSo) procedure retains an aganglionic muscular cuff, which may cause obstructive symptoms. The laparoscopic-assisted Swenson-like (LASwL) technique completely excises the aganglionic segment, potentially improving peristalsis. However, randomized evidence comparing these techniques with combined functional and quality-of-life outcomes is lacking.<\/jats:p>\n                  <jats:p>This study aimed to compare surgical, functional, and quality-of-life outcomes between LASwL and LAYaSo pull-through procedures in a randomized controlled trial.<\/jats:p>\n                  <jats:p>This prospective, single-center, randomized study included 110 children with HD at Al-Azhar University Hospitals (2020\u20132025). The inclusion criterion was biopsy-confirmed rectosigmoid HD. Exclusion criteria were ultrashort or total colonic aganglionosis, prior pull-through procedures, and major congenital anomalies. Patients were randomized to LASwL (n\u2009=\u200955) or LAYaSo (n\u2009=\u200955) using a computer-generated sequence and sequentially numbered, opaque, sealed envelopes (SNOSE). The primary outcome was the Rintala Bowel Function Score (BFS) at 2 years. Secondary outcomes included BFS at 1 year (exploratory), operative time, blood loss, hospital stay, Hirschsprung-associated enterocolitis (HAEC), and health-related quality of life (Pediatric Quality of Life Inventory [PedsQL] 4.0).<\/jats:p>\n                  <jats:p>All procedures were completed laparoscopically without conversion. Mean total operative time was shorter for LASwL (145.5\u2009\u00b1\u200936.8 vs. 160.3\u2009\u00b1\u200928.6\u2009minutes, p\u2009=\u20090.081), with a significantly shorter transanal phase (p\u2009=\u20090.019). At the primary endpoint of 2 years, BFS was significantly higher in the LASwL group (18.20\u2009\u00b1\u20091.80 vs. 17.10\u2009\u00b1\u20092.30, p\u2009=\u20090.037). HAEC rates were 14.5% versus 20.0% (p\u2009=\u20090.61), all mild\/moderate. At 2 years, total PedsQL scores were comparable (88.6\u2009\u00b1\u20097.5 vs. 86.2\u2009\u00b1\u20098.4, p\u2009=\u20090.12), though social functioning was numerically higher in LASwL (p\u2009=\u20090.055). Three LAYaSo patients required redo surgery for cuff-related stricture.<\/jats:p>\n                  <jats:p>Both techniques are safe and effective. LASwL offers a modest but statistically significant advantage in bowel function at intermediate follow-up (1.1 points on the Rintala score) without a corresponding improvement in overall quality of life. LAYaSo was associated with a 5.5% risk of cuff-related stricture requiring reoperation. The limited clinical magnitude of the benefit supports individualized technique selection based on surgeon experience and patient factors. Single-center design and the need for longer follow-up are limitations of this study.<\/jats:p>","DOI":"10.1055\/a-2913-8311","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T22:46:17Z","timestamp":1785192377000},"page":"405-413","source":"Crossref","is-referenced-by-count":0,"title":["Laparoscopic-Assisted Swenson-Like versus Soave Pull-Through in Hirschsprung Disease: A Randomized Comparative Study of Functional Outcomes"],"prefix":"10.1055","volume":"36","clinical-trial-number":[{"clinical-trial-number":"nct07186647","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Ashraf Hamed","family":"Seddek","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Azhar University, Cairo, Egypt","place":["Nasr City"],"department":["Department of Pediatric 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Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"El Gohary","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Azhar University, Cairo, Egypt","place":["Nasr City"],"department":["Department of Pediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Abdel-Aziz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Azhar University, Cairo, Egypt","place":["Nasr City"],"department":["Department of Pediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1038\/s41572-023-00465-y","article-title":"Hirschsprung disease","volume":"9","author":"L Montalva","year":"2023","journal-title":"Nat Rev Dis 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