Comparative efficacy of Soave versus Swenson procedures for Hirschsprung disease: a systematic review and meta-analysis.

OBJECTIVE

To compare the efficacy of Soave and Swenson procedures in the treatment of Hirschsprung disease (HSCR) through meta-analysis, and to provide evidence-based support for surgical choice.

METHODS

A systematic search of Chinese and English databases was performed to identify clinical studies comparing the two procedures. Extracted outcomes included perioperative parameters, postoperative complications, and long-term bowel function. Data were analyzed using Review Manager 5.4.1 and Stata 17.0.

RESULTS

Eleven retrospective cohort studies involving 972 children (506 Soave, 466 Swenson) were included. Compared with Soave, Swenson was associated with shorter operative time (MD: 26.39 min; 95% CI: 11.32-41.46; P < 0.001), reduced intraoperative blood loss (MD: 15.53 ml; 95% CI: 13.83-17.24; P < 0.001), and shorter postoperative hospital stay (MD: 1.50 days; 95% CI: 0.27-2.72; P = 0.02). No significant differences were found in early complications. Postoperative constipation was less frequent after Swenson (OR = 2.20; 95% CI: 1.04-4.64; P = 0.04), while no significant differences were observed for Hirschsprung-associated enterocolitis (HAEC), urinary retention, or other long-term outcomes.

CONCLUSION

The Soave and Swenson procedures each have their own characteristics. Swenson improves surgical efficiency and reduces constipation, while Soave, with its clearer anatomical planes, may lower the risk of pelvic nerve injury and remains widely applied. Surgical choice should be individualized, and prospective multicentre studies are needed to optimize long-term outcomes in HSCR.