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The Optimal Suture Bite Depth in Laparoscopic Pyeloplasty: A Comparative Study in Children
Shaodong Gu1,2,3, Hong Luo1,2,3
1Department of Pediatric Surgery, The First People's Hospital of Lianyungang, Lianyungang, China.
Insights
A deeper suture bite depth during laparoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO) in children may reduce urine extravasation and complications. This technique improved recovery times and reduced the need for stent replacement.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Surgical Technique Optimization
Background:
- Modified Anderson-Hynes pyeloplasty is the preferred surgical approach for ureteropelvic junction obstruction (UPJO).
- Common complications include urine extravasation and anastomotic stenosis, often linked to suturing technique.
- Current guidelines lack specific recommendations for suture bite depth during pyeloplasty.
Purpose of the Study:
- To determine the optimal suture bite depth for laparoscopic Anderson-Hynes pyeloplasty.
- To evaluate the impact of suture bite depth on postoperative outcomes in pediatric UPJO patients.
Main Methods:
- Prospective study of 90 children (4-14 years) with UPJO-induced hydronephrosis.
- Laparoscopic Anderson-Hynes pyeloplasty performed using 5-0 Vicryl continuous sutures.
- Patients divided into two groups based on suture bite depth: Group A (1 mm) and Group B (0.5 mm).
Main Results:
- Group A (1 mm bite depth) demonstrated significantly lower postoperative drainage volume.
- Shorter times for ureteral stent removal and hydronephrosis resolution were observed in Group A (P < .05).
- Fewer complications, including reduced need for double-J stent replacement, were noted with deeper bites.
Conclusions:
- A deeper suture bite depth (1 mm) in laparoscopic pyeloplasty appears to minimize postoperative urine extravasation.
- This technique may reduce associated complications and improve recovery in pediatric UPJO patients.
- Optimizing suture technique is crucial for successful pyeloplasty outcomes.
Abstract:
Modified Anderson-Hynes pyeloplasty is currently preferred for ureteropelvic junction obstruction (UPJO). Extravasation of urine and anastomotic stenosis are the most common complications after Anderson-Hynes pyeloplasty, which are closely linked with the technique for anastomosis. However, there are currently no clear guidelines for the suture bite depth in suturing the anastomosis during pyeloplasty. To analyze the optimal suture bite depth in laparoscopic Anderson-Hynes pyeloplasty. A total of 90 children aged 4-14 years with UPJO-induced hydronephrosis who were surgically treated in the First People's Hospital of Lianyungang from July 2019 to July 2022 were prospectively recruited. All received laparoscopic Anderson-Hynes pyeloplasty using 5-0 Vicryl continuous sutures. According to the suture bite depth, the patients were divided into group A (depth 1 mm, n = 46) and group B (depth 0.5 mm, n = 44). Operation time, postoperative drainage volume, time of ureteral stent removal, incidence of postoperative complications, and time to hydronephrosis resolution were compared between groups. Group A showed significantly less postoperative drainage volume, and shorter time of ureteral stent removal and hydronephrosis resolution (all P < .05). Four cases in group B received replacement of a double-J stent. Except for 1 patient receiving reoperation for anastomotic stenosis caused by massive extravasation of urine, the replaced double-J stent was successfully removed from the remaining 3 patients at 3 months, and the symptoms of anastomotic stenosis disappeared. No significant difference was detected in the operation time between groups (P > .05). An appropriate deeper suture bite depth for anastomosis may reduce postoperative urine extravasation and related complications in children who received laparoscopic pyeloplasty for UPJO-induced hydronephrosis.
