Abstract
ABSTRACTObjective: To evaluate the value of adding fibrin glue, as a sealant material, to the anastomotic line during stentless laparoscopic pyeloplasty (LPP).Patients and methods: In all, 92 patients with pelvi-ureteric junction obstruction (PUJO), scheduled for LPP, were randomised into two groups (46 in each group). Group A, underwent transperitoneal stentless LLP sealed with fibrin glue, whilst Group B underwent the same procedure without fibrin glue.Results: Both groups were similar for patient demographics and presentation. Despite that, we found a significant statistical difference between the groups for operative time and blood loss. The total number of patients that had a urinary leak was 10 and 24 patients, in groups A and B respectively (P = 0.002). A prolonged leak lasting for >5 days, which stopped spontaneously occurred in three patients (7.14%) in Group A and six (14.3%) in Group B (P = 0.265). A persistent 14-day leak that needed intervention developed in two patients (4.3%) in Group A and five (10.9%) in Group B (P = 0.434). One patient in Group B developed urinoma 1 week after discharge, and another patient in the same group developed deep venous thrombosis. There was no significant difference between the groups for postoperative complications in the early 3-month period. The success rate was 39 (92.86%) and 36 patients (85.7%), in groups A and B respectively (P = 0.265).Conclusion: Adding fibrin glue to seal the anastomosis decreased urinary leakage but did not have a significant impact on outcomes.Abbreviations: CONSORT: Consolidated Standards of Reporting Trials; DTPA: diethylene-triamine-penta-acetic acid; LPP: laparoscopic pyeloplasty; PUJO: PUJ obstruction; T½: clearance halftime (renogram)
Highlights
PUJ obstruction (PUJO) occurs in nearly one in 500 to one in 1250 live births
The Anderson-Hynes dismembered pyeloplasty is the ‘gold standard’ for treating PUJO, with the success rate estimated to be as high as 90% [1]
There was no significant difference in presentation of both groups, except for split renal function, where the fibrin group (Group A) had a higher mean compared to the no fibrin group (Group B; Table 1)
Summary
PUJ obstruction (PUJO) occurs in nearly one in 500 to one in 1250 live births. The Anderson-Hynes dismembered pyeloplasty is the ‘gold standard’ for treating PUJO, with the success rate estimated to be as high as 90% [1].Over the past two decades, laparoscopic pyeloplasty (LPP) has been developing as an alternative procedure and is becoming more or less a standard practice. As there is prolonged leakage and hospital stay in stentless LPP, especially in the paediatric age group [8–10], it is plausible, at least theoretically, that adding fibrin glue on the suture line as a sealant material could be used to decrease urinary leakage and promote healing [11]. In the present study, we aimed to assess the value and effectiveness of adding fibrin glue, as a sealant material, to the anastomotic suture line during stentless LPP.
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