{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T10:51:16Z","timestamp":1782471076035,"version":"3.54.5"},"reference-count":52,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Objective: Minimally invasive surgery in Hirschsprung disease (HSCR) management was introduced in the mid-1990s. Despite decades of clinical application of various laparoscopic approaches, there remains a paucity of high-powered prospective studies and comprehensive systematic reviews in the literature. This study aimed to systematically review and summarize published techniques and outcomes of laparoscopic- and robotic-assisted surgery in HSCR. Methods: A systematic literature review was conducted using PubMed and the Cochrane Library. Studies reporting technical and outcome data of laparoscopic- or robotic-assisted surgery for HSCR were included. Data extraction and analysis were performed in accordance with the PRISMA 2020 guidelines. Parameters of interest included surgical technique, age at primary pull-through (PT), operative time, and functional outcomes. Outcomes of laparoscopic- versus robotic-assisted Yancey\u2013Soave PT were compared. Results: A total of 700 publications were screened, of which seven studies met the inclusion criteria. Data from 556 patients were analyzed. A total of 338 underwent laparoscopic-assisted, and 218 underwent robotic-assisted pull-through. Large variability of the reported transanal resection technique (modified Yancey\u2013Soave PT) was reported. Four studies reported functional outcomes in patients aged over four years. Three studies directly compared laparoscopic- and robotic-assisted PT; two reported no difference in the incidence of postoperative Hirschsprung-associated enterocolitis (HAEC). Functional outcomes were assessed using the Krickenbeck classification in three studies and the bowel function score in one study, with no significant differences reported in patients aged &gt;4 years. Conclusions: Laparoscopic- and robotic-assisted Yancey\u2013Soave PT appears to be safe for HSCR. Large variability in the applied surgical technique\u2014despite being commonly classified as modified Yancey\u2013Soave PT\u2014as well as heterogeneity in the bowel function assessment, limit direct comparability between studies. To date, no single minimally invasive approach has demonstrated clear superiority over others. Prospective, randomized controlled studies are required to enable robust comparative evaluation of techniques, overall costs, and outcomes.<\/jats:p>","DOI":"10.3390\/children13070846","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T08:43:57Z","timestamp":1782463437000},"page":"846","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Laparoscopic Versus Robotic Yancey\u2013Soave Primary Pull-Through in Rectosigmoid Hirschsprung Disease: A Systematic Review of the Literature"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5557-5985","authenticated-orcid":false,"given":"Lea A.","family":"Wehrli","sequence":"first","affiliation":[{"name":"Pediatric Surgery, WVU Medicine Golisano Children\u2019s Hospital, Morgantown, WV 26505, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico G.","family":"Seifarth","sequence":"additional","affiliation":[{"name":"Pediatric Surgery, WVU Medicine Golisano Children\u2019s Hospital, Morgantown, WV 26505, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/j.jpedsurg.2008.02.039","article-title":"Older age at diagnosis of Hirschsprung disease decreases risk of postoperative enterocolitis, but resection of additional ganglionated bowel does not","volume":"43","author":"Haricharan","year":"2008","journal-title":"J. Pediatr. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1053\/j.sempedsurg.2009.11.016","article-title":"Transanal endorectal pull-through for Hirschsprung disease: Technique, controversies, pearls, pitfalls, and an organized approach to the management of postoperative obstructive symptoms","volume":"19","author":"Langer","year":"2010","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/s00383-017-4065-8","article-title":"Guidelines for the diagnosis and management of Hirschsprung-associated enterocolitis","volume":"33","author":"Gosain","year":"2017","journal-title":"Pediatr. Surg. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1016\/j.jpedsurg.2022.03.030","article-title":"Asa G Yancey: The first to describe a modification of the Swenson Technique for Hirschsprung disease","volume":"57","author":"Woode","year":"2022","journal-title":"J. Pediatr. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"A1","DOI":"10.1016\/j.jss.2024.08.002","article-title":"The Story of Dr. Asa G. Yancey and Surgical Innovation in the Face of Discrimination","volume":"302","author":"Gerardo","year":"2024","journal-title":"J. Surg. Res."},{"key":"ref_6","first-page":"2127","article-title":"Methodological quality of case series studies: An introduction to the JBI critical appraisal tool","volume":"18","author":"Munn","year":"2020","journal-title":"JBI Evid. Synth."},{"key":"ref_7","unstructured":"Wells, G.A., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2026, April 13). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analyses. Available online: https:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp#:~:text=It was developed to assess the quality of,quality assessments in the interpretation of meta-analytic results."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1002\/hsr2.2165","article-title":"The Cochrane risk of bias assessment tool 2 (RoB 2) versus the original RoB: A perspective on the pros and cons","volume":"7","author":"Nejadghaderi","year":"2024","journal-title":"Health Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/j.jpedsurg.2016.02.020","article-title":"Laparoscopic-assisted transanal pull-through (LATP) versus complete transanal pull-through (CTP) in the surgical management of Hirschsprung\u2019s disease","volume":"51","author":"Guerra","year":"2016","journal-title":"J. Pediatr. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1089\/lap.2023.0448","article-title":"Total Transanal Endorectal Pull-through Versus Laparoscopic-Assisted Approach in Children with Rectosigmoid Hirschsprung\u2019s Disease: A Systematic Review and Meta-Analysis","volume":"35","author":"Wang","year":"2025","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.ijscr.2015.09.005","article-title":"One-stage laparoscopy-assisted endorectal pull-through for late presented Hirschsprung \u2019 s disease\u2014Case series","volume":"16","author":"Nam","year":"2015","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Li, W., Lin, M., Hu, H., Sun, Q., Su, C., Wang, C., Li, Y., Li, Y., Chen, J., and Luo, Y. (2022). Surgical Management of Hirschsprung \u2019 s Disease: A Comparative Study Between Conventional Laparoscopic Surgery, Transumbilical Single-Site Laparoscopic Surgery, and Robotic Surgery. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.924850"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Li, Y., He, S., Jin, Z., Tang, C., Gong, Y., Huang, L., Du, Q., and Xia, X. (2025). Comparison of robot-assisted and laparoscopic-assisted modified Soave short muscle cuff anastomosis surgeries for classical Hirschsprung disease. BMC Surg., 25.","DOI":"10.1186\/s12893-025-02799-8"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1097\/SLA.0000000000006172","article-title":"Robotic-assisted Proctosigmoidectomy Versus Laparoscopic-assisted Soave Pull-through for Hirschsprung Disease: Medium-term Outcomes From a Prospective Multicenter Study","volume":"281","author":"Zhang","year":"2025","journal-title":"Ann. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1089\/lap.2020.0549","article-title":"Long-Term Results of One-Stage Laparoscopic-Assisted Endorectal Pull-Through for Rectosigmoid Hirschsprung\u2019s Disease in Patients Aged Above 5 Years","volume":"31","author":"Chan","year":"2021","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e1632","DOI":"10.1097\/MD.0000000000001632","article-title":"Comparison of Laparoscopic-Assisted Operations and Laparotomy Operations for the Treatment of Hirschsprung Disease Evidence from a Meta-Analysis","volume":"94","author":"Zhang","year":"2015","journal-title":"Medicine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e006063","DOI":"10.1136\/bmjopen-2014-006063","article-title":"Laparoscopic assistance for primary transanal pull-through in Hirschsprung\u2019s disease: A systematic review and meta-analysis","volume":"5","author":"Thomson","year":"2015","journal-title":"BMJ Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1007\/s00383-016-3910-5","article-title":"Laparoscopic-assisted pull-through operation for Hirschsprung\u2019s disease: A systematic review and meta-analysis","volume":"32","author":"Tomuschat","year":"2016","journal-title":"Pediatr. Surg. Int."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Dai, Y., Deng, Y., Lin, Y., Ouyang, R., and Li, L. (2020). Long-term outcomes and quality of life of patients with Hirschsprung disease: A systematic review and meta-analysis. BMC Gastroenterol., 20.","DOI":"10.1186\/s12876-020-01208-z"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1007\/s11701-025-02836-x","article-title":"Robotic surgery for Hirschsprung disease: A systematic review and meta-analysis","volume":"19","author":"Langeron","year":"2025","journal-title":"J. Robot. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1089\/lps.1994.4.273","article-title":"Laparoscopic Duhamel pullthrough procedure for Hirschsprung\u2019s disease in childhood","volume":"4","author":"Smith","year":"1994","journal-title":"J. Laparoendosc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Li, Z., Li, W., Wang, H., and Xu, M. (2025). Comparison of robotic-assisted and laparoscopic-assisted surgery in the treatment of children with Hirschsprung\u2019s disease: A systematic review and meta-analysis. Front. Pediatr., 13.","DOI":"10.3389\/fped.2025.1638198"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s11701-026-03170-6","article-title":"Outcomes of robotic-assisted soave pull-through procedure for Hirschsprung disease: A systematic review and meta-analysis","volume":"20","author":"Rizvi","year":"2026","journal-title":"J. Robot. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1053\/j.sempedsurg.2012.07.002","article-title":"Laparoscopic and transanal pull-through for Hirschsprung disease","volume":"21","author":"Langer","year":"2012","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1016\/j.jpedsurg.2009.02.050","article-title":"Contemporary practice patterns in the surgical management of Hirschsprung\u2019s disease","volume":"44","author":"Keckler","year":"2009","journal-title":"J. Pediatr. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"8903","DOI":"10.3748\/wjg.v21.i29.8903","article-title":"Clinical outcomes and ergonomics analysis of three laparoscopic techniques for Hirschsprung\u2019s disease","volume":"21","author":"Aubdoollah","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1089\/lap.2011.0081","article-title":"10 Years of Experience with Laparoscopic-Assisted Endorectal Soave Pull-Through Procedure for Hirschsprung\u2019s Disease in China","volume":"22","author":"Tang","year":"2012","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1007\/s00383-008-2231-8","article-title":"Transanal mucosectomy for endorectal pull-through in Hirschsprung\u2019s disease: Comparison of abdominal, extraanal and transanal approaches","volume":"24","author":"Ishikawa","year":"2008","journal-title":"Pediatr. Surg. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3715","DOI":"10.3748\/wjg.v29.i23.3715","article-title":"Robotic-assisted proctosigmoidectomy for Hirschsprung\u2019s disease: A multicenter prospective study","volume":"29","author":"Zhang","year":"2023","journal-title":"World J. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1016\/j.jpedsurg.2019.08.052","article-title":"Long-term outcomes of laparoscope-assisted heart-shaped anastomosis for children with hirschsprung disease: A 10-year review study","volume":"55","author":"Zhuansun","year":"2020","journal-title":"J. Pediatr. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s00383-025-05988-x","article-title":"Robotic-assisted Swenson procedure for Hirschsprung\u2019s disease with a median age of 35 days: A single\u2014center retrospective study","volume":"41","author":"Hou","year":"2025","journal-title":"Pediatr. Surg. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1177\/000313481107700735","article-title":"Robotic Swenson Pull-Through for Hirschsprung\u2019s Disease in infants","volume":"77","author":"Hebra","year":"2011","journal-title":"Am. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Zhang, S., Cai, D., Zhang, Y., Pan, T., Chen, K., Jin, Y., Luo, W., Huang, Z., Hu, D., and Chen, Q. (2023). Comparation of robotic-assisted surgery and laparoscopic-assisted surgery in children with Hirschsprung\u2019s disease: A single-centered retrospective study. BMC Surg., 23.","DOI":"10.1186\/s12893-023-02169-2"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s00383-019-04593-z","article-title":"Totally robotic soave pull-through procedure for Hirschsprung\u2019s disease: Lessons learned from 11 consecutive pediatric patients","volume":"36","author":"Pini","year":"2020","journal-title":"Pediatr. Surg. Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.jpedsurg.2004.10.025","article-title":"The versatility of the umbilical incision in the management of Hirschsprung\u2019s disease","volume":"40","author":"Sauer","year":"2005","journal-title":"J. Pediatr. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e000887","DOI":"10.1136\/wjps-2024-000887","article-title":"Controversies in Hirschsprung surgery","volume":"7","author":"Xu","year":"2024","journal-title":"World J. Pediatr. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1053\/spsu.2002.35350","article-title":"Laparoscopic-Assisted Pull-Through for Hirschsprung\u2019s Disease","volume":"11","author":"Georgeson","year":"2002","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_38","first-page":"96","article-title":"Evaluating single incision laparoscopy-assisted extracorporeal biopsy as an alternative to frozen sections in the management of Hirschsprung disease","volume":"80","author":"Perdana","year":"2025","journal-title":"Med. J. Malays."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1016\/0022-3468(94)90823-0","article-title":"The Feasibility of Laparoscopic Swenson Pull-Through","volume":"29","author":"Curran","year":"1994","journal-title":"J. Pediatr. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/0022-3468(95)90333-X","article-title":"Primary Laparoscopic Pull-Through for Hirschsprung\u2019s Disease in Infants and Children","volume":"30","author":"Georgeson","year":"1995","journal-title":"J. Pediatr. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.1007\/s11605-010-1299-3","article-title":"Single-Incision Laparoscopic Endorectal Pull-Through (SILEP) for Hirschsprung Disease","volume":"14","author":"Muensterer","year":"2010","journal-title":"J. Gastrointest. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1097\/00000658-199905000-00010","article-title":"Primary Laparoscopic-Assisted Endorectal Colon Pull-Through for Hirschsprung\u2019s Disease A New Gold Standard","volume":"229","author":"Georgeson","year":"1999","journal-title":"Ann. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1016\/S0140-6736(17)32284-5","article-title":"Advances in paediatric gastroenterology","volume":"390","author":"Tam","year":"2017","journal-title":"Lancet"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1089\/lap.2015.0121","article-title":"Laparoscopic Duhamel Procedure Systematic Review and Meta-analysis","volume":"26","author":"Scholfield","year":"2016","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.jpedsurg.2023.10.017","article-title":"Duhamel Versus Swenson Pull-Through for Total Colonic Aganglionosis: A Multi-Institutional Study","volume":"59","author":"Halaweish","year":"2024","journal-title":"J. Pediatr. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1007\/s00383-025-06137-0","article-title":"Postoperative outcomes of robotic\u2013assisted vs. laparoscopic pull\u2013through surgery in pediatric Hirschsprung\u2019s disease: A systematic review and meta\u2013analysis","volume":"41","author":"Durazo","year":"2025","journal-title":"Pediatr. Surg. Int."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1016\/j.jpedsurg.2017.08.040","article-title":"The anal canal is the fine line between \u201cfecal incontinence and colitis\u201d after a pull-through for Hirschsprung disease","volume":"52","author":"Cogley","year":"2017","journal-title":"J. Pediatr. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.jpedsurg.2016.08.027","article-title":"Damaged anal canal as a cause of fecal incontinence after surgical repair for Hirschsprung disease\u2014A preventable and under-reported complication","volume":"52","author":"Bischoff","year":"2017","journal-title":"J. Pediatr. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/S0022-3468(97)90628-X","article-title":"Do children with repaired low anorectal malformations have normal bowel function?","volume":"32","author":"Rintala","year":"1997","journal-title":"J. Pediatr. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Lindert, J., Telle Hoel, A., Schmiedeke, E., Curry, J.I., Loukogeorgakis, S., and Amerstorfer, E. (2024). Bowel Function Score in Long-Term Follow-Up for Children with Hirschsprung Disease: OASIS-Holistic Care in Hirschsprung Disease Network Position Paper. Children, 11.","DOI":"10.3390\/children11111284"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1007\/s00383-023-05516-9","article-title":"Gastrointestinal quality of life and bowel function in adults born with anorectal malformation and hirschsprung disease","volume":"39","author":"Wehrli","year":"2023","journal-title":"Pediatr. Surg. Int."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e000859","DOI":"10.1136\/wjps-2024-000859","article-title":"Long-term outcomes and quality of life in patients with Hirschsprung disease","volume":"7","author":"Pakarinen","year":"2024","journal-title":"World J. Pediatr. Surg."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/7\/846\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T10:25:42Z","timestamp":1782469542000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/7\/846"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,23]]},"references-count":52,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["children13070846"],"URL":"https:\/\/doi.org\/10.3390\/children13070846","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,23]]}}}