Vaginal Uterosacral Ligament Suspension: A Retrospective Cohort of Absorbable and Permanent Suture Groups

Bradley, Megan S.; Bickhaus, Jennifer A.; Amundsen, Cindy L.; Newcomb, Laura K.; Truong, Tracy; Weidner, Alison C.; Siddiqui, Nazema Y.

doi:10.1097/spv.0000000000000451

Cited by 17 publications

(13 citation statements)

References 23 publications

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“…Others have used both permanent and absorbable sutures [13, 19]. Bradley MS et al [20] and Unger CA et al [19] have addressed this issue; however, none of them found any difference in recurrence of apical prolapse when retrospectively comparing women operated with absorbable or permanent sutures.…”

Section: Discussionmentioning

confidence: 99%

Recurrent apical prolapse after high uterosacral ligament suspension – in a heterogenous cohort characterised by a high prevalence of previous pelvic operations

et al. 2019

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Background The apical prolapse is probably the most complex form of pelvic organ prolapse (POP). Adequate apical support is essential in the treatment of POP, as it contributes to the support in all vaginal compartments. This study aimed to evaluate the rate of symptomatic recurrent apical prolapse after high uterosacral ligament suspension (HUSLS), in a cohort of women characterised by a high prevalence of previous pelvic operations and a significant degree of prolapse. Methods This is a retrospective chart review of 95 women who underwent HUSLS for symptomatic apical prolapse from 2002 to 2009 at Aarhus University Hospital, Denmark. Of these women, 97% attended a six-month clinical control. Recurrence was defined as symptomatic vaginal vault prolapse stage 2 or more (according to the International Continence Society (ICS) quantification system). Medical charts were reviewed for a mean period of 7.2 years. Any new contacts due to prolapse were noted. Results Before the operation, 73% of the women were hysterectomised, and 52% had previous prolapse surgery. Stage 2 apical prolapse was reported in 71% of the women, whereas 26% had stage 3 or 4. At six-month follow-up, 19% of the women had recurrent symptomatic apical prolapse, and 9% of the women had symptomatic recurrent prolapse in other compartments 6 months after operation. In all, 35% of the women had a renewed prolapse operation during the long-term follow-up period. Perioperative adverse events were seen in 7%. Two women were re-operated due to postoperative complications. Conclusions This retrospective study of 95 women with a significant degree of prolapse and a high prevalence of previous pelvic operations demonstrates that the rate of recurrent prolapse associated with HUSLS might be higher than originally described. In conclusion, HUSLS may not be the optimal first choice of operation in this group of patients.

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Section: Discussionmentioning

confidence: 99%

Recurrent apical prolapse after high uterosacral ligament suspension – in a heterogenous cohort characterised by a high prevalence of previous pelvic operations

et al. 2019

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“…There have been controversial reports regarding the succes rates of permanent and absorbable suture materials in uterosacralligament suspension surgery 24,25 . Lowenstein et al and Matanes et al used absorbable sutures for suspending the vaginal apex to the uterosacral ligaments.…”

Section: Discussionmentioning

confidence: 99%

Apical pelvic organ prolapse repair via vaginal‐assisted natural orifice transluminal endoscopic surgery: Initial experience from a tertiary care hospital

Alay

Kaya

Cengiz

et al. 2020

Asian J Endoscop Surgery

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Introduction Natural orifice transluminal endoscopic surgery has been used for gynecologic operations in recent years. The aim of the study is to describe our initial experience using vaginal‐assisted natural orifice transluminal endoscopic surgery (vNOTES) for apical pelvic organ prolapse repair. Methods After patients underwent vaginal hysterectomy, vNOTES sacrocolpopexy (n = 4) or vNOTES high uterosacral ligament suspension (n = 7) were performed to treat symptomatic apical pelvic organ prolapse. Sociodemographic and clinical characteristics, Pelvic Organ Prolapse Quantification results, and recorded surgical data (eg, duration of surgery, intraoperative complications, additional prolapse and incontinence surgeries) were obtained from patient files and the hospital's database. Information from postoperative follow‐up visits, including complications and anatomical results, were also recorded. Results The mean age of the patients was 60.7 ± 9.1 years. The mean total operative time was 121.3 ± 22.7 minutes. The mean operative time for vaginal hysterectomy, vNOTES sacrocolpopexy, and vNOTES uterosacral ligament suspension was 46 ± 11.9, 65 ± 38, 25 ± 8.2 minutes, respectively. There were no intraoperative and postoperative complications observed. The mean postoperative 24‐hour visual analog scale score was 3.5 ± 1.9 for vNOTES sacrocolpopexy patients and 3.2 ± 0.9 for vNOTES uterosacral ligament suspension patients. Only one patient in the vNOTES sacrocolpopexy group had a recurrence; she experienced stage 2 anterior compartment prolapse 8 months after surgery. Conclusion As a treatment for apical pelvic organ prolapse, vNOTES is a feasible approach in both sacrocolpopexy and uterosacral ligament suspension.

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“…After the removal of unavailable and noncomparative studies, six articles were selected in the qualitative synthesis. However, two trials 17,18 that provided insufficient data were not eligible for metaanalysis and four works [7][8][9]19 including one RCT 9 and three retrospective studies 7,8,19 involving 647 patients (cohort size 44-246 patients) were eventually selected. Table 1 showed the characteristics and surgical success definition of each included study.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…the success of apical support, the obtained RR was based on three eligible studies [7][8][9] and the findings suggested that AS for USLS demonstrated comparable success rate in comparison with PS (RR = 1.00; 95% CI, 0.94-1.06). No publication bias was identified regarding the surgical success rate (Figure S1A).…”

Section: Success Of Apical Supportmentioning

confidence: 99%

“…Several modifications of this procedure have been made, such as performing with different combinations of permanent and absorbed suture (AS), either combined or used separately. 7,8 Although the suture material used in the primary study was permanent braided suture, recent research using AS in USLS have concluded similar surgical results. 9,10 Additionally, PS for suspension of vaginal vault prolapse might be associated with a relatively higher suture erosion rate (36%-44.6%) in single-arm studies.…”

Section: Introductionmentioning

confidence: 98%

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Is absorbable suture superior to permanent suture for uterosacral ligament suspension?

Liao

Liu

et al. 2020

Neurourology and Urodynamics

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Aims The aims of this study were to compare surgical results and suture‐related complications after uterosacral ligament suspension (USLS) with absorbable suture (AS) vs permanent suture (PS). Methods We systematically searched PubMed, Embase, http://clinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials for articles that compared AS with PS for USLS. The primary outcomes were surgical success rate and suture‐related complications (suture exposure/erosion and suture removal). Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) was applied to conduct all analyses. Results Four articles involving 647 patients were eventually included. Our findings demonstrated that AS had a similar surgical success rates in comparison with PS (RR = 1.00; 95% CI, 0.94‐1.06) and that no significant differences in anatomic failure rates were noted between two groups (RR = 1.10; 95% CI, 0.65‐1.86). Subgroup analyses in anatomic failure revealed no statistical differences in apical prolapse ≥1/2 TVL (RR = 0.92; 95% CI, 0.48‐1.75), recurrent prolapse beyond the hymen (RR = 1.18; 95% CI, 0.68‐2.04), as well as in recurrent anterior, posterior or apical prolapse (P = .14, P = .08, P = .09, respectively). However, AS group indicated a lower risk in suture exposure/erosion (RR = 0.31; 95% CI, 0.15‐0.63) and lower suture removal rate (RR = 0.35; 95% CI, 0.18‐0.67). Conclusions Due to similar surgical results, less suture exposure/erosion and less suture removal, the current data supported that AS is as effective as PS, but with a better safety profile.

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Vaginal Uterosacral Ligament Suspension: A Retrospective Cohort of Absorbable and Permanent Suture Groups

Abstract: Completion of vaginal uterosacral ligament suspension using only absorbable suture affords similar anatomic outcomes in the medium term as compared with suspension with additional permanent suture.

Cited by 17 publications

References 23 publications

Recurrent apical prolapse after high uterosacral ligament suspension – in a heterogenous cohort characterised by a high prevalence of previous pelvic operations

Recurrent apical prolapse after high uterosacral ligament suspension – in a heterogenous cohort characterised by a high prevalence of previous pelvic operations

Apical pelvic organ prolapse repair via vaginal‐assisted natural orifice transluminal endoscopic surgery: Initial experience from a tertiary care hospital

Is absorbable suture superior to permanent suture for uterosacral ligament suspension?

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