A Pilot Study Comparing Anatomic Failure after Sacrocolpopexy with Absorbable or Permanent Sutures for Vaginal Mesh Attachment

Tan-Kim, Jasmine; Menefee, Shawn A.; Lippmann, Quinn K.; Lukacz, Emily S.; Luber, Karl M.; Nager, Charles W.

doi:10.7812/tpp/14-022

Cited by 20 publications

(3 citation statements)

References 12 publications

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“…Thirty-nine studies with 3,349 patients met inclusion criteria for the sacrocolpopexy category. Three compared both suture types, 9,39,40 and 36 used one suture type (20 permanent [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] and 16 absorbable 8,61-75 ); 2,045 patients underwent sacrocolpopexy with permanent suture, and 1,304 with absorbable suture. Overall, nine studies were RCTs, 12 were comparative (two prospective, nine retrospective, one unclear direction), and 18 were single-arm (six prospective, 12 retrospective).…”

Section: Resultsmentioning

confidence: 99%

Permanent Compared With Absorbable Suture in Apical Prolapse Surgery

Pollack

Popiel

Toaff

et al. 2023

Obstetrics &Amp; Gynecology

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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.

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Section: Resultsmentioning

confidence: 99%

Permanent Compared With Absorbable Suture in Apical Prolapse Surgery

Pollack

Popiel

Toaff

et al. 2023

Obstetrics &Amp; Gynecology

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Section: Discussionmentioning

confidence: 99%

“…One retrospective study compared absorbable and permanent sutures for vaginal mesh attachment and found no difference in recurrence rate. The main fear regarding the use of non-absorbable sutures on the vagina is the possible risk of mesh or suture erosion (Tan-Kim et al, 2014). Presently, there is no consensus regarding the best way to fix the mesh to the promontory, as non-absorbable sutures, staples, and tackers have all proven to have similar results (Costantini et al, 2016;Moroni et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Practice of laparoscopic prolapse surgery in Europe – ESGE Survey

Lambert,

de Landsheere,

Noé

et al. 2023

Facts Views Vis ObGyn

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Sacrocolpopexy is considered as the “gold standard” for management of women with apical prolapse. Numerous technical variants are being practiced. The first aim of this survey was to determine the habits of practice of laparoscopic sacrocolpopexy (LSCP) in Europe. The second aim was to determine whether surgeons who perform laparoscopic pelvic organ prolapse (POP) repair are familiar with the practice of alternative techniques and with mesh-less laparoscopic treatment of prolapse. The questionnaire was designed by the Urogynaecology Special Interest Group of the European Society for Gynaecological Endoscopy (ESGE). All ESGE-members were invited by email to respond to this survey consisting of 54 questions divided in different categories. Following review of ESGE member’s responses, we have highlighted the great heterogeneity concerning the practice of LSCP and important variability in performance of concomitant surgeries. Alternative techniques are rarely used in practice. Furthermore, the lack of standardisation of the many surgical steps of a laparoscopic sacrocolpopexy is mainly due to the lack of evidence. There is a need for training and teaching in both standard and newer innovative techniques as well as the reporting of medium and long-term outcomes of both standard laparoscopic sacrocolpopexy and any of its alternatives.

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