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)