Comparative efficacy and safety of Cohen versus Lich-Gregoir ureteral reimplantation in pediatric vesicoureteral reflux: a systematic review and meta-analysis

Background: Cohen and Lich-Gregoir ureteral reimplantation techniques are the most commonly used surgical approaches for correcting vesicoureteral reflux (VUR) in children. While both techniques aim to restore the anti-reflux mechanism by lengthening the intramural ureter, their comparative efficacy and safety remain controversial. This meta-analysis aimed to systematically evaluate and compare the perioperative outcomes and postoperative complications of the Cohen and Lich-Gregoir procedures in pediatric patients with VUR. Methods: A systematic search of PubMed, Embase, Cochrane Library, CNKI, Wanfang, and VIP databases was conducted in May 2025 following PRISMA guidelines, registered under PROSPERO (CRD420251058493). Studies comparing Cohen and Lich-Gregoir techniques in pediatric VUR were included. Meta-analysis was performed using RevMan 5.3. Subgroup analyses were conducted for unilateral and bilateral VUR. Results: Eight retrospective studies involving 1,314 patients were included. Overall, the Lich-Gregoir technique was associated with shorter operative time (MD: 22.37 min, 95% CI [11.34-33.40]) and reduced hospital stay (MD: 2.65 days, 95% CI [1.59-3.71]). It also demonstrated lower risks of bladder spasms (OR: 5.93), hematuria (OR: 21.42), and overall complications. No significant differences were observed in postoperative catheter duration, persistent VUR, or urinary tract infection. Subgroup results were consistent with the overall findings. Conclusions: Compared to the Cohen technique, Lich-Gregoir reimplantation may offer advantages in operative efficiency and complication profile, especially in bilateral cases. These findings provide clinical insight but require further confirmation through high-quality prospective studies.