Skip to main content
SpringerLink
Log in

Reattachment of the endopelvic fascia to the apex during anterior colporrhaphy: does the type of suture matter?

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

We aimed to determine if the use of permanent suture for the apical fixation during traditional anterior colporrhaphy results in improved outcomes compared to delayed absorbable suture.

Methods

A retrospective case-control study was performed in patients who underwent traditional non-grafted anterior colporrhaphy with reattachment of the anterior endopelvic fascia to the apex/cervix comparing permanent (group 1) or absorbable suture (group 2). Patients were matched based on age, body mass index, and presenting stage of prolapse. The primary outcome assessed was anterior wall vaginal prolapse recurrence defined as Pelvic Organ Prolapse Quantification (POP-Q) points Aa or Ba ≥ −1 cm. Secondary outcome measures included overall prolapse stage, subjective reporting of satisfaction, and any healing abnormalities or complications resulting from suture type.

Results

A total of 230 patients were reviewed (80 in group 1 and 150 in group 2) and median follow-up was 52 (24–174) weeks. A statistically significant improvement in anterior wall anatomy was seen in group 1 compared to group 2 [(Aa −2.70 ± 0.6 cm vs −2.5 ± 0.75 cm, p = 0.02) and Ba (−2.68 ± 0.65 cm vs −2.51 ± 0.73 cm, p = 0.03), respectively]. Comparing prolapse stage, there were no observed differences between the groups. Exposure of the permanent suture occurred in 12 patients (15 %) and 5 (6.5 %) required suture trimming to treat the exposure.

Conclusions

Reattachment of endopelvic fascia to the apex at the time of anterior colporrhaphy results in low recurrence rates. Use of permanent suture for apical fixation is associated with improved anatomic correction at the expense of increased suture exposures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Tegerstedt G, Maehle-Schmidt M, Nyrén O, Hammarström M (2005) Prevalence of symptomatic pelvic organ prolapse in a Swedish population. Int Urogynecol J Pelvic Floor Dysfunct 16:497–503

    Article  PubMed  Google Scholar 

  2. Rortveit G, Brown JS, Thom DH, Van Den Eeden SK, Creasman JM, Subak LL (2007) Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol 109:1396–1403

    Article  PubMed  Google Scholar 

  3. Shah AD, Kohli N, Rajan SS, Hoyte L (2008) The age distribution, rates, and types of surgery for pelvic organ prolapse in the USA. Int Urogynecol J Pelvic Floor Dysfunct 19:421–428

    Article  PubMed  Google Scholar 

  4. Nichols DH, Randall CH (1996) Vaginal surgery, 4th edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  5. Rock JA, Jones HW (2003) Te Linde’s operative gynecology, 9th edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  6. Kelly HA (1913) Incontinence of urine in women. Urol Cutan Rev 17:291–293

    Google Scholar 

  7. Weber AM, Walters MD, Piedmonte MR, Ballard LA (2001) Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 185:1299–1304

    Article  PubMed  CAS  Google Scholar 

  8. Sand PK, Koduri S, Lobel RW et al (2001) Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol 184:1357–1362

    Article  PubMed  CAS  Google Scholar 

  9. Nguyen JN, Burchette RJ (2008) Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol 111:891–898

    Article  PubMed  Google Scholar 

  10. Milani R, Salvatore S, Soligo M, Pifarotti P, Meschia BM, Cortese M (2005) Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with prolene mesh. BJOG 112:107–111

    Article  PubMed  Google Scholar 

  11. de Tayrac R, Devoldere D, Renaudie J, Villard P, Guilbaud O, Eglin G, French Ugytex Study Group (2007) Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study. Int Urogynecol J Pelvic Floor Dysfunct 18:251–256

    Article  PubMed  Google Scholar 

  12. Rogers RG (2011) To mesh or not to mesh: current debates in prolapse repair fueled by the U.S. Food and Drug Administration Safety Notification. Obstet Gynecol 118(4):771–773

    Article  PubMed  Google Scholar 

  13. Iglesia CB, Sokol AI, Sokol ER, Kudish BI, Gutman RE, Peterson JL, Shott S (2010) Vaginal mesh for prolapse: a randomized controlled trial. Obstet Gynecol 116:293–303

    Article  PubMed  Google Scholar 

  14. Goldstein HB, Vakili B, Franco N, Echols KT, Chesson R (2007) The effect of suture material on outcomes of surgery for pelvic organ prolapse. Pelviperineology 26:174–177

    Google Scholar 

  15. Peterson T, Karp DR, Aguilar V, Davila GW (2010) Primary versus recurrent prolapsed surgery: differences in outcomes. Int Urogynecol J 21:483–488

    Article  PubMed  Google Scholar 

  16. Chung CP, Miskimins R, Kuehl TJ, Yandell PM, Shull BL (2012) Permanent suture used in uterosacral ligament suspension offers better anatomical support than delayed absorbable suture. Int Urogynecol J 23:223–227

    Article  PubMed  Google Scholar 

  17. Goldberg RP, Koduri S, Lobel RW et al (2001) Protective effect of suburethral slings on postoperative cystocele recurrence after reconstructive pelvic operation. Am J Obstet Gynecol 185:1307–1312

    Article  PubMed  CAS  Google Scholar 

  18. Tantanasis T, Giannoulis C, Daniilidis A, Papathanasiou K, Loufopoulos A, Tzafettas J (2008) Tension free vaginal tape underneath bladder base: does it prevent cystocele recurrence? Hippokratia 12:108–112

    PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

GW Davila: consultant and honoraria: Astellas, Watson, American Medical Systems, Novasys Medical, CL Medical; research funding: American Medical Systems, Astellas. Other authors: none.

Author information

Authors and Affiliations

  1. Department of Gynecology, Urogynecology & Reconstructive Pelvic Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA

    Salomon Zebede, Aimee L. Smith, Roger Lefevre, Vivian C. Aguilar & G. Willy Davila

Authors
  1. Salomon Zebede
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aimee L. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roger Lefevre
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vivian C. Aguilar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Willy Davila
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Willy Davila.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zebede, S., Smith, A.L., Lefevre, R. et al. Reattachment of the endopelvic fascia to the apex during anterior colporrhaphy: does the type of suture matter?. Int Urogynecol J 24, 141–145 (2013). https://doi.org/10.1007/s00192-012-1862-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-012-1862-4

Keywords

Search

Navigation