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Suture over and Over interrupted and Continuous

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Abstract

Pelvi-ureteric anastomosis is a critical step to ensure good outcome of pyeloplasty. Continuous suturing technique, especially for laparoscopic surgeries, may offer faster operative time while allowing water-tight anastomosis and remains an alternative to interrupted suturing technique. There has been mixed data on comparison of outcomes of continuous and interrupted suturing techniques. This systematic review and meta-analysis aim to assess the outcomes of pyeloplasty based on continuous and interrupted suturing techniques. Following protocol registration on PROSPERO (CRD42021269706), a systematic review was performed in accordance with Cochrane Collaboration. A literature search was performed in September 2021 across Medline, EMBASE, Scopus, Cochrane Library, and ClinicalTrials.gov. Records comparing pyeloplasty outcomes between continuous and interrupted suture techniques were included. Five studies were identified for inclusion (2 prospective, 3 retrospective). Three studies involved pediatric patients. Three studies exclusively assessed laparoscopic technique. Four outcomes were meta-analyzed: operative time, length of stay, complications, and pyeloplasty failure. Interrupted sutures had longer OR time (mean difference 33.14 min [95% CI 29.35–36.94], p < 0.0001) and length of stay (mean difference 1.08 days [95% CI 0.84–1.32], p < 0.0001). However, there were similar complication (OR 1.73 [95% CI 0.98–3.06], p = 0.06) and failure rates (OR 1.21 [95% CI 0.43–3.43], p = 0.71) between the two suture types. The overall risk of bias in the studies was high. While limited by the number of studies available, continuous sutures for pelvi-ureteric anastomosis appear to confer benefits of faster operative time and decreased length of stay without increasing complication rates or failures.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada

    Jin K. Kim, Min Joon Lee, Bruce Gao, Priyank Yadav, Mandy Rickard, Armando J. Lorenzo & Michael E. Chua

  2. Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Jin K. Kim, Min Joon Lee, Bruce Gao, Armando J. Lorenzo & Michael E. Chua

  3. Department of Surgery, University of New Mexico, Albuquerque, NM, USA

    Jessica M. Ming

  4. Institute of Urology, St. Luke's Medical Center, Quezon, Philippines

    Michael E. Chua

Contributions

Conception and design of data: Jin Kyu Kim, Michael E. Chua, Armando J. Lorenzo, Mandy Rickard, Jessica Ming Acquisition of data: Jin Kyu Kim, Michael E. Chua, Min Joon Lee, Bruce Gao, Priyank Yadav Analysis & Interpretation of data: Jin Kyu Kim, Michael E. Chua, Min Joon Lee, Priyank Yadav Drafting the manuscript: Jin Kyu Kim, Min Joon Lee, Bruce Gao, Michael E. Chua, Priyank Yadav, Jessica Ming Critical revision of the manuscript: Jin Kyu Kim, Michael E. Chua, Priyank Yadav, Mandy Rickard, Armando J. Lorenzo, Jessica Ming Statistical analysis: Jin Kyu Kim, Michael E. Chua Supervision: Michael E. Chua, Armando J. Lorenzo, Mandy Rickard

Corresponding author

Correspondence to Jin K. Kim.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Kim, J.K., Lee, M.J., Gao, B. et al. Comparison of continuous and interrupted suture techniques in pyeloplasty: a systematic review and meta-analysis. Pediatr Surg Int 38, 1209–1215 (2022). https://doi.org/10.1007/s00383-022-05173-4

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  • DOI : https://doi.org/10.1007/s00383-022-05173-4

Keywords

  • Suture
  • Pyeloplasty
  • Ureteropelvic junction obstruction
  • UPJO
  • Minimally invasive surgery
  • MIS

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