{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T16:20:41Z","timestamp":1788366041239,"version":"build-2803163510"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To describe technical evolution of minimally invasive surgery (MIS) for total colonic aganglionosis (TCA) either Duhamel or Swenson procedures conducted by a single pediatric surgical team.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      18 children with histologically proven TCA were managed between March 2018 and March 2022. All underwent laparoscopic definitive pull-through: Group A (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098) received laparoscopic-assisted transanal Swenson-type ileoanal pull-through, and Group B (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910) underwent laparoscopic Duhamel procedure. Thirteen patients presented with a pre-existing ileostomy; five were primary cases. Pre-operative evaluation included contrast enema and full-thickness rectal biopsy in every patient.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median age at definitive surgery was 3 years (range 18 months\u20135 years; mean\u2009\u00b1\u2009SD\u2009=\u20093.0\u2009\u00b1\u20090.9 years). Median operative time was 4\u2005h (range 3.5\u20135.5\u2005h) for Group A and 5\u2005h (range 4.5\u20136\u2005h) for Group B. Median follow-up was 5 years (range 3\u20136 years). Early complications included two anastomotic stenoses (Group A) successfully treated with dilatation. No anastomotic leaks occurred. Median daily stool frequency at 6 months was 7 (range 5\u201310) in Group A vs. 5 (range 4\u20137) in Group B, improving to 3 (range 2\u20134) and 2 (range 1\u20133), respectively, by last follow-up. Fecal incontinence occurred in two patients (Group A). Three patients required loperamide and six cases used dietary fiber modification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Laparoscopic management of TCA is safe and feasible. Both Swenson-type and Duhamel approaches yield acceptable continence and growth outcomes, with the choice tailored to rectal anatomy and continence risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1882822","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T15:57:05Z","timestamp":1788364625000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Developing expertise in laparoscopic management of total colonic aganglionosis cases: Duhamel vs. Swenson procedures"],"prefix":"10.3389","volume":"13","author":[{"given":"Ahmed","family":"Arafa","sequence":"first","affiliation":[{"name":"Pediatric Surgery Department, Faculty of Medicine, Cairo University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Hamed","family":"Abouelfadl","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Faculty of Medicine, Cairo University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belal","family":"Eldomiaty","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Faculty of Medicine, Cairo University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aboubakr","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Faculty of Medicine, Cairo University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Azzam","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Faculty of Medicine, Cairo University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Qinawy","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Faculty of Medicine, Cairo University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seham","family":"Anwar","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Faculty of Medicine, Beni Suef University","place":["Beni Suef, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed S.","family":"Ragab","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Faculty of Medicine, Portsaid University","place":["Port Said, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1016\/S0022-3468(98)90515-2","article-title":"Long-term morbidity in total colonic aganglionosis","volume":"33","author":"Hoehner","year":"1998","journal-title":"J Pediatr Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2226","DOI":"10.1016\/j.jpedsurg.2008.08.049","article-title":"Total colonic aganglionosis with or without small bowel involvement: a 30-year retrospective nationwide survey in Japan","volume":"43","author":"Ieiri","year":"2008","journal-title":"J Pediatr Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1007\/s00383-011-2960-y","article-title":"Total colonic aganglionosis: a surgical challenge. 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