Use of fibrin glue as a sealant at the anastomotic line in laparoscopic pyeloplasty: A randomised controlled trial

Abstract

ObjectiveTo assess the effectiveness of fibrin glue as a sealant at the anastomotic line of a stentless laparoscopic pyeloplasty (LPP) repair instead of JJ stent insertion.Patients and methodsIn all, 46 patients with pelvi-ureteric junction obstruction scheduled for LPP were randomised into two groups each containing 23 patients. Group A underwent stented repair, while group B had a stentless repair together with sealing of the anastomotic line with fibrin glue.ResultsThere was no statistically significant difference between the groups for the postoperative improvement in the renal scan and intravenous urography. However, there was a statistically significant decrease in early postoperative adverse events in group B. In group A, all the patients had irritative lower urinary tract symptoms (LUTS) and 16 (72.7%) had postoperative urinary tract infections (UTIs). In group B, no patient had a UTI or irritative LUTS. In all, 21 patients (95.4%) in group A had minimal terminal painful haematuria; while in group B, only one patient (4.3%) had minimal total painless haematuria. Also, patients in group B were spared the need for a second anaesthesia exposure for stent removal.ConclusionThe use of fibrin glue is a valid alternative to stenting in LPP with the same excellent outcome but with markedly lower short-term postoperative adverse events.

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

“…In 2016, we reported on the effectiveness of fibrin glue as a sealant in stentless LPP and compared it to stented LPP. Although the mean values of urinary leakage and hospital stay were almost equal in both groups, three patients in the stentless group had prolonged urinary leakage and therefore had longer hospital stays (>7 days) than the patients in the stented group [19].…”

Recent advances in urologic surgical techniques for pyeloplasty

“…With the introduction of laparoscopic pyeloplasty, the placement of a double-J stent across the ureteropelvic junction became an indispensable step of the surgery as it facilitates performing of laparoscopic anastomosis and maintains ureteric caliber and anastomotic alignment. Furthermore, a stent is considered to lower the risk of urinoma formation, thereby reducing periureteric fibrosis and restenosis 39 and lower the impact of post-operative edema at the anastomotic site. A big disadvantage of stenting is that it can cause significant patient discomfort 39 , 40 .…”

“…Furthermore, a stent is considered to lower the risk of urinoma formation, thereby reducing periureteric fibrosis and restenosis 39 and lower the impact of post-operative edema at the anastomotic site. A big disadvantage of stenting is that it can cause significant patient discomfort 39 , 40 . For example, Joshi et al 40 claim that more than 80% of patients experienced stent-related pain affecting daily activities, 32% experienced sexual dysfunction, and 58% experienced reduced work capacity.…”

“…Although the risk of prolonged anastomotic leakage and hospital stay are initially higher in the non-stented pyeloplasty, success rates for stented and non-stented pyeloplasty are the same 45 . The advantages of stentless pyeloplasty are the avoidance of stent-related morbidity and the need for a second intervention for stent removal which makes such an approach cost-effective 2 , 39 . Nevertheless, almost all authors emphasize that the stentless procedure should be performed only by an experienced surgeon and the decision should be made in light of patient characteristics and intra-operative findings 44 , 45 .…”

“…Some authors proposed, as an aid in performing a stentless procedure, that fibrin glue can be used as a sealant at the anastomotic line. Fibrin glue is a mixture of coagulation factors which can be used as a urinary tract sealant (mostly in urological anastomoses), tissue adhesive, and hemostatic agent 39 , 46 . In an RCT, Farouk et al 39 proved that omitting stenting during laparoscopic pyeloplasty in combination with fibrin glue can significantly reduce the rate of early post-operative adverse events and complications.…”