Barbed Versus Non-Barbed Suture for Pyeloplasty via the Minimally Invasive Approach: A Systematic Review and Meta-Analysis

Abstract

Background: 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. Materials and Methods: 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. Results: 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, P = .01), with statistically significant estimated heterogeneity among the included studies (P < .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 (P = .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, P = .88). Conclusions: 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.

Keywords: barbed; knotless; laparoscopy; minimally invasive surgery; pyeloplasty; robotic.