title: Unfavorable outcomes of laparoscopic pyeloplasty using barbed sutures: a multi-center experience.
abstract: OBJECTIVE
  Barbed self-retaining sutures (SRS) have been introduced as an advance in suture technology, facilitating reconstructive laparoscopic surgery. We present the experience of three centers performing laparoscopic pyeloplasty with the use of SRS.
  
  
  METHODS
  Preoperative, intraoperative and follow-up data were collected for 6 patients undergoing pyeloplasty using the Quill SRS (Angiotech, Vancouver, CAN) in three centers. Standard laparoscopic pyeloplasty technique was used and a knot-less continuous anastomosis between the spatulated ureter and the renal pelvis was created.
  
  
  RESULTS
  Knot-less uretero-pelvic anastomosis creation was feasible in all six cases. Peri-operative data were similar to standard pyeloplasty using conventional suture materials. A very high stricture recurrence rate (5/6 patients) was noted during follow-up. Further endourologic and open interventions were needed to address the recurrence of the strictures.
  
  
  CONCLUSIONS
  Knotless intracorporeal laparoscopic suturing using SRS for the reconstruction of UPJ during laparoscopic pyeloplasty is associated with high rates of stricture recurrence at least in the initial cases of each surgeon. Until further investigations elucidate the cause of treatment failure, SRS should not be recommended for upper urinary tract reconstruction.
authors.affiliation: Department of Urology, University of Patras Medical School, Rion, 26 500, Patras, Greece, liatsikos@yahoo.com.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Liatsikos
authors.forename: Thomas
authors.initials: T
authors.lastname: Knoll
authors.forename: Iason
authors.initials: I
authors.lastname: Kyriazis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Georgiopoulos
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kallidonis
authors.forename: Patrick
authors.initials: P
authors.lastname: Honeck
authors.forename: Jens Uwe
authors.initials: JU
authors.lastname: Stolzenburg
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013537:Sutures / Q000009:adverse effects*; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000453:epidemiology / Q000601:surgery