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.