Absorbable versus non-absorbable sutures for vaginal mesh attachment during sacrocolpopexy: a randomized controlled trial

Reisenauer, Christl; Andress, Jürgen; Schoenfisch, Birgitt; Huebner, Markus; Brucker, Sara Y.; Lippkowski, Andrea; Beilecke, Kathrin; Marschke, Juliane; Tunn, Ralf

doi:10.1007/s00192-021-04853-4

Cited by 13 publications

(7 citation statements)

References 30 publications

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“…As proved by numerous studies, suture type used for vaginal graft attachment did not influence mesh or permanent suture exposure rates ( Reisenauer et al, 2021 ). The high risk of relapses related to the weakness of connective tissue led us to the choice of resorting to the use of prosthetic materials and non-absorbable sutures during this laparoscopic approach, since in our experience they are associated to low complication rate and good long term outcome, avoiding surgical techniques with native tissues.…”

Section: Discussionmentioning

confidence: 88%

Laparoscopic sacral hysteropexy for pelvic organ prolapse in a patient affected by marfan syndrome: a case report

Campagna¹,

Vacca²,

Caramazza³

et al. 2021

Facts Views Vis ObGyn

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Background: Marfan Syndrome (MS) is a dominantly inherited connective tissue disorder with consequences on the strength and resilience of connective tissues that may predispose to Pelvic Organ Prolapse (POP). Literature lacks studies investigating POP surgery in patients affected by MS that might help surgical management decisions. Objective: The objective of this paper is to describe the surgical procedure of laparoscopic sacral hysteropexy (LSHP) in a 37 years old woman affected by MS with symptomatic POP. Materials and Methods and main outcome measures: We performed a nerve-sparing laparoscopic sacral hysteropexy without complications and looked for anatomical and subjective outcomes. The patient completed The Female Sexual Distress Scale (FSDS), Pelvic Floor Disability Index (PFDI-20), and Wexner questionnaires preoperatively and postoperatively. Results: The patient stated a complete resolution of all POP related symptoms and there was a total correction of the descensus. Furthermore, no perioperative and postoperative complications were noted. Conclusions: LSHP could be an effective and safe procedure for the treatment of POP in women affected by MS and this case report is the first to describe a reconstructive procedure in this category of patients. What is new? The literature lacks studies investigating POP surgery in women with MS, that might help surgeons, thus we present this case to describe surgical and functional outcomes in this patient category, underlying the higher risk of complications and relapses related to the weakness of connective tissue. This case report may represent the basis of future studies to confirm the safety, efficacy and feasibility of LSHP and sacral colpopexy in patients with MS.

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Section: Discussionmentioning

confidence: 88%

Laparoscopic sacral hysteropexy for pelvic organ prolapse in a patient affected by marfan syndrome: a case report

Campagna¹,

Vacca²,

Caramazza³

et al. 2021

Facts Views Vis ObGyn

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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 41–60 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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“…In the SALTO trial nonresorbable sutures were used, which might contribute to these exposures. Nowadays, it is common practice to use resorbable sutures, which might lead to fewer suture exposures [ 28 ]. There were no other surgery-related risk factors in our study population, such as concomitant hysterectomy [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic sacrocolpopexy versus abdominal sacrocolpopexy for vaginal vault prolapse: long-term follow-up of a randomized controlled trial

et al. 2022

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Introduction and hypothesis The objective of this study was to evaluate long-term outcomes of laparoscopic sacrocolpopexy (LSC) versus abdominal sacrocolpopexy (ASC) for vaginal vault prolapse (VVP). Methods Long-term follow-up of a multicenter randomized controlled trial (SALTO trial). A total of 74 women were randomly assigned to LSC ( n =37) or ASC ( n =37). Primary outcome was disease-specific quality of life, measured with validated questionnaires. Secondary outcomes included anatomical outcome, composite outcome of success, complications, and retreatment. Results We analyzed 22 patients in the LSC group and 19 patients in the ASC group for long-term follow-up, with a median follow-up of 109 months (9.1 years). Disease-specific quality of life did not differ after long-term follow-up with median scores of 0.0 (LSC: IQR 0–17; ASC: IQR 0–0) on the “genital prolapse” domain of the Urogenital Distress Inventory in both groups ( p = 0.175). Anatomical outcomes were the same for both groups on all points of the POP-Q. The composite outcome of success for the apical compartment is 78.6% ( n = 11) in the LSC group and 84.6% ( n = 11) in the ASC group ( p = 0.686). Mesh exposures occurred in 2 patients (12.5%) in the LSC group and 1 patient (7.7%) in the ASC group. There were 5 surgical reinterventions in both groups (LSC: 22.7%; ASC: 26.3%, p = 0.729). Conclusions At long-term follow-up no substantial differences in quality of life, anatomical results, complications, or reinterventions between LSC and ASC were observed. Therefore, the laparoscopic approach is preferable, considering the short-term advantages. Trial registration Dutch Trial Register NTR6330, 18 January 2017, https://www.trialregister.nl/trial/5964

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Absorbable versus non-absorbable sutures for vaginal mesh attachment during sacrocolpopexy: a randomized controlled trial

Cited by 13 publications

References 30 publications

Laparoscopic sacral hysteropexy for pelvic organ prolapse in a patient affected by marfan syndrome: a case report

Laparoscopic sacral hysteropexy for pelvic organ prolapse in a patient affected by marfan syndrome: a case report

Permanent Compared With Absorbable Suture in Apical Prolapse Surgery

Laparoscopic sacrocolpopexy versus abdominal sacrocolpopexy for vaginal vault prolapse: long-term follow-up of a randomized controlled trial

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