Fibrin glue as a sealant in stentless laparoscopic pyeloplasty: A randomised controlled trial

Abstract

Objective : 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)

Outcomes of laparoscopic pyeloplasty and impact of an enhanced recovery protocol

“…It is also impractical to reduce (resect) the pelvis during pyeloplasty because it does not affect the outcome of the operation [20]. One author presents two similar works demonstrating the effectiveness of fibrin glue during pyeloplasty according to the tubeless protocol, which reduces urine leakage and improves treatment outcomes [21]. We consider it expedient to reduce surgical trauma further by using mini laparoscopic techniques, which is confirmed by some early works [22].…”

Efficacy and safety of intravesical fibrin glue instillation for management of patients with refractory hemorrhagic cystitis: 12-months results. A promising therapy for hemorrhagic cystitis

“…Moreover, our study showed that the procedure is repeatable and that results are reliable over time as showed by our relative long follow-up of approximately 12 months. The use of FG as a hemostatic agent have been previously studied in urological surgery and the use of the Vivostat ® system have been proven to be effective and safety when applied to urological surgery, in particular to prevent bleeding in renal surgery and lymphatic leakage in lymphadenectomy (18)(19)(20)(21). However, only few studies investigated its use for the treatment of HC.…”