Do Barbed Sutures Make a Difference in Laparoscopic Pyeloplasty? A Single Centre Experience Comparing V-LocTM and Vicryl for Adult Pelvi-ureteric Junction Obstruction
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Abstract
Introduction: Laparoscopic intracorporeal suturing is technically challenging with a much steeper proficiency gaining curve. Although barbed self-retaining sutures have been employed effectively for various laparoscopic procedures requiring suturing, their role in laparascopic pyeloplasty has not been well studied. Therefore, we aimed to compare the efficacy and outcomes of barbed vs non barbed sutures for laparoscopic pyeloplasty in adults. Methods: Between January 2020 and December 2023, all adult patients satisfying the eligibility criteria who underwent laparoscopic pyeloplasty either using 4-0 V-LocTM 90(Group1) or 4-0 Vicryl suture (Group2) were retrospectively evaluated. Both the groups were compared for patient demographics, perioperative and post-operative variables, complications, and renal function. Success was defined as the absence of clinical symptom combined with a patent unobstructed or improved/stable renal function on a DTPA renogram. Results: 90 patients fit the eligibility criteria with 45 in each group. Demographic and clinical criteria were comparable. Congenital PUJO (54.4%) was the most common aetiology with anterior crossing vessel in 12 patients. Mean intracorporeal suturing time (32.78 ± 12.32 minutes) and the mean total operative time (153. 54 ± 20. 56minutes) was significantly shorter in the V-LocTM group (p<0. 0001). None of the laparoscopic pyeloplasties were converted to open procedure. Post-operative drain removal and hospital stay was significantly delayed in the vicryl group. Perioperative and post-operative complications were similar with a success rate of 97. 7%. No deterioration of function was noted on follow up DTPA renogram. Median follow up duration was 2. 3 years with 1 in each group developing recurrence. Conclusion: Laparoscopic transperitoneal pyeloplasty using unidirectional barbed suture(V-LocTM) is safe and feasible with similar functional outcomes and significantly lesser operative times.
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Copyright (c) 2026 Dr Tarun Javali, Dr Varun G Huilgol, Dr Manasa T, Dr Puvvada Sandeep, YASHAS PRASAD MYLARAPPA
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