Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.
Department of Pediatric Surgery, University Hospital of Split, Split, Croatia.
J Laparoendosc Adv Surg Tech A. 2022 Oct;32(10):1056-1063. doi: 10.1089/lap.2021.0868. Epub 2022 May 12.
There is no agreed protocol on usage of proper and best suturing material in minimally invasive pyeloplasty. The aim of this meta-analysis was to summarize and analyze current evidence on suturing materials for laparoscopic pyeloplasty. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Scientific databases (PubMed, Scopus, Web of Science, and EMBASE) were systematically searched for relevant comparative studies on barbed suture (BS) and non-barbed suture (NBS) in minimally invasive pyeloplasty. Five comparative studies met the inclusion criteria and were included in the meta-analysis. Pooling the data demonstrated a significantly shorter operative duration in patients belonging to the BS group versus the NBS group (95% confidence interval [CI] -81.63 to -10.41, = .01), with statistically significant estimated heterogeneity among the included studies ( < .0001). Although the incidence of redo-pyeloplasty was higher in the BS group, the pooled risk ratio (RR) for the need for redo-pyeloplasty in subjects belonging to the BS group versus the NBS group was 6.00 (95% CI 0.78-46.14), demonstrating no statistically significant difference ( = .09). A total of 5 patients developed postoperative complications. The pooled RR for the occurrence of these complication showed no significant difference among the patients belonging to both the groups (95% CI 0.22-6.05, = .88). Minimally invasive pyeloplasty using BS is associated with significantly shorter operative time. The incidence of postoperative complications and requirement of redo-pyeloplasty showed no significant difference among both the treatment groups. Further randomized controlled trials need to be conducted before any definite conclusions are drawn.
在微创肾盂成形术中，使用合适和最佳缝合材料没有达成共识的方案。本荟萃分析的目的是总结和分析腹腔镜肾盂成形术缝合材料的现有证据。本研究按照系统评价和荟萃分析的首选报告项目进行。系统地在科学数据库（PubMed、Scopus、Web of Science 和 EMBASE）中搜索关于微创肾盂成形术中使用带倒刺缝线（BS）和非带倒刺缝线（NBS）的相关比较研究。符合纳入标准的五项比较研究被纳入荟萃分析。汇总数据表明，BS 组患者的手术时间明显短于 NBS 组（95%置信区间 [CI] -81.63 至 -10.41， = .01），纳入研究之间存在统计学显著的异质性（ < .0001）。尽管 BS 组 redo-pyeloplasty 的发生率较高，但 BS 组与 NBS 组相比， redo-pyeloplasty 需求的汇总风险比（RR）为 6.00（95%CI 0.78-46.14），无统计学显著差异（ = .09）。共有 5 名患者发生术后并发症。两组患者发生这些并发症的汇总 RR 无显著差异（95%CI 0.22-6.05， = .88）。使用 BS 的微创肾盂成形术与明显缩短的手术时间相关。两组患者的术后并发症发生率和 redo-pyeloplasty 需求无显著差异。在得出任何明确结论之前，需要进行更多的随机对照试验。
