Efficacy of Swenson versus Soave operations in treatment of Hirschsprung disease; a systematic review and meta-analysis

Abstract

Abstract Background Hirschsprung disease (HD) is definitively treated by resecting the aganglionic bowel segment and performing a pull-through procedure, with the Swenson and Soave techniques being two of the most widely adopted. This systematic review and meta-analysis aim to compare their global efficacy and safety profiles. Methods We systematically searched PubMed, Web of Science, Scopus, and the Cochrane Library for retrospective clinical studies comparing the Soave and Swenson surgeries. Data regarding intraoperative parameters, short-term complications, and long-term functional outcomes were pooled using a random-effects model. Results Eight studies encompassing 506 pediatric patients were included. The Swenson procedure was associated with significantly shorter operative times (MD = 26.73 min, P < 0.00001) and lower intraoperative blood loss (MD = 13.69 ml, P < 0.00001) compared to the Soave procedure. Conversely, the Soave group demonstrated a higher mean defecation frequency on the final day of hospital stay (MD = 1.20, P = 0.004). Notably, there were no statistically significant differences between the procedures regarding hospital stay duration, short-term adverse events (e.g., anastomotic stricture, leaks, obstruction), or long-term complications (e.g., colon prolapse, incontinence, enterocolitis). Conclusion We detected no statistically significant differences between the Swenson and Soave procedures regarding short- and long-term adverse events, though certainty is limited by sparse data. The Swenson approach appears to offer better intraoperative efficiency; however, these findings must be interpreted with caution, given the retrospective nature and clinical heterogeneity of the included studies. Future randomized controlled trials incorporating standardized functional outcome metrics are recommended to guide clinical decision-making further.