Permanent Compared With Absorbable Suture in Apical Prolapse Surgery

Abstract

To explore how permanent compared with absorbable suture affects anatomic success in native tissue vaginal suspension (uterosacral ligament suspension and sacrospinous ligament suspension) and sacrocolpopexy with mesh.DATA SOURCES: MEDLINE, EMBASE, and ClinicalTrials. gov were searched through March 29, 2022. METHODS OF STUDY SELECTION:Our population included women undergoing apical prolapse surgery (uterosacral ligament suspension and sacrospinous ligament suspension and abdominal sacrocolpopexy). Our intervention was permanent suture for apical prolapse surgery, and our comparator was absorbable suture. We determined a single anatomic success proportion per study. Adverse events collected included suture and mesh exposure, surgery for suture and mesh complication, dyspareunia, and granulation tissue. Abstracts were doubly screened, fulltext articles were doubly screened, and accepted articles were doubly extracted. Quality of studies was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. In single-arm studies using either permanent or absorbable suture, random effects meta-analyses of pooled proportions were used to assess anatomic success. In comparative studies investigating both suture types, random effects meta-analyses of pooled risk ratios were used.TABULATION, INTEGRATION, AND RESULTS: Of 4,658 abstracts screened, 398 full-text articles were assessed and 63 studies were included (24 vaginal suspension [13 uterosacral ligament suspension and 11 sacrospinous ligament suspension] and 39 sacrocolpopexy). At 2-year follow-up, there was no difference in permanent compared with absorbable suture in uterosacral ligament suspension and sacrospinous ligament suspension (proportional anatomic success rate 88% [95% CI 0.81-0.93] vs 88% [95% CI 0.82-0.92]). Similarly, at 18-month follow-up, there was no difference in permanent compared with absorbable suture in sacrocolpopexy (proportional anatomic success rate 92% [95% CI 0.88-0.95] vs 96% [95% CI 0.92-0.99]). On metaanalysis, there was no difference in relative risk (RR) of success for permanent compared with absorbable suture for uterosacral ligament suspension and sacrospinous ligament suspension (RR 1.11, 95% CI 0.93-1.33) or sacrocolpopexy (RR 1.00, 95% CI0.98-1.03). CONCLUSION: Success rates were similarly high for absorbable and permanent suture after uterosacral ligament suspension, sacrospinous ligament suspension, and sacrocolpopexy, with medium-term follow-up.

Comparison of transvaginal natural orifice transluminal endoscopic surgery versus conventional surgery for uterosacral ligament suspension in patients who had concomitant vaginal hysterectomy for subtotal uterine prolapse

“…Although previous studies have utilized permanent nonabsorbable suture materials for the suspension of the vaginal vault, these studies completed the surgical procedures without exposing the suture within the vaginal cavity 13,14 . Permanent sutures may lead to complications such as infection, suture erosion, and granuloma formation 15,16 . The rationale behind using a permanent suture was the theoretical advantages it offers over an absorbable suture for apical suspension.…”

Supramolecular Fibrous Hydrogel Augmentation of Uterosacral Ligament Suspension for Treatment of Pelvic Organ Prolapse

“…It was a delayed absorbable suture that had a slower degradation rate compared to other sutures such as Vicryl. PDS had been showed to be equally successful compared to permanent suture in humans, [ 92 ] making it a clinically reasonable choice in humans as well as in the rat model. Tying the sutures down simultaneously closed the vaginal vault and elevated it toward the USLs.…”

At the Scrub Sink: Uterosacral Ligament Suspension

“…Investigations have found no difference in outcomes with permanent versus delayed absorbable sutures, and permanent sutures have an increased risk of complications. 4 Although the classic technique across the midline was 2 sutures, and the classic ipsilateral technique included 3 braided sutures per side, many variations exist. Many surgeons prefer monofilament sutures, both to minimize tearing the perineum and to avoid the increased complications, such as exposure and granulation, with braided suture.…”

“…The next pressing question is the number and type of sutures to use. Investigations have found no difference in outcomes with permanent versus delayed absorbable sutures, and permanent sutures have an increased risk of complications 4 . Although the classic technique across the midline was 2 sutures, and the classic ipsilateral technique included 3 braided sutures per side, many variations exist.…”