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

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Abstract

Introduction and hypothesis

The purpose of the study was to analyze anatomical and functional outcomes after sacrocolpopexy (SCP) for vaginal vault prolapse pelvic organ prolapse quantification (POPQ) II–III by random use of absorbable (Vicryl) and non-absorbable sutures (Ethibond) for vaginal mesh fixation.

Methods

This study was designed as a two-center randomized controlled study (RCT). The primary objective was to evaluate the anatomical outcome. Success was defined when the vaginal apex (point C; POPQ) did not descend more than 50% of the total vaginal length (tvl) during Valsalva. Patients completed a pelvic examination incorporating the POPQ and questionnaires (the German pelvic floor questionnaire and the PISQ-12 questionnaire) at baseline and 6 months postsurgery. Perioperative adverse events (AE) were recorded. Sample size calculations, based on a 10% non-inferiority limit required 100 participants per group, with power = 90%.

Results

In 190 out of 195 women (ETH group n = 96; VIC group n = 94) anatomical success was achieved. The relative risk of anatomical success failure in the VIC group versus the ETH group was 0.69, with a 95% confidence interval 0.12–4.02. The change in the symptom scores did not differ significantly between the ETH and the VIC group. In the ETH group, three suture penetrations into the vagina were observed, and none in the VIC group 6 months postoperatively.

Conclusions

Anatomical success after SCP for vaginal vault prolapse POPQ II–III is not affected by suture type for vaginal monofilament mesh attachment. Moreover, we did not see any differences in functional outcomes between the two groups. Three suture penetrations into the vagina were observed in the ETH group, and none in the VIC group 6 months postoperatively.

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References

  1. Nygaard I, Brubaker L, Zyczynski HM, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309:2016–24.

    Article  CAS  Google Scholar 

  2. Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol. 2004;190:20–6.

    Article  Google Scholar 

  3. Siddiqui NY, Grimes CL, Casiano ER, et al. Mesh sacrocolpopexy compared with native tissue vaginal repair: a systematic review and meta-analysis. Obstet Gynecol. 2015;125:44–55.

    Article  Google Scholar 

  4. Matthews CA, Geller EJ, Henley BR, et al. Permanent compared with absorbable suture for vaginal mesh fixation during total hysterectomy and sacrocolpopexy: a randomized controlled trial. Obstet Gynecol. 2020;136:355–64. https://doi.org/10.1097/AOG.0000000000003884.

    Article  CAS  PubMed  Google Scholar 

  5. Tagliaferri V, Ruggieri S, Taccaliti C, et al. Comparison of absorbable and permanent sutures for laparoscopic sacrocervicopexy: a randomized controlled trial. Acta Obstet Gynecol Scand. 2021;100:347–52. https://doi.org/10.1111/aogs.13997.

    Article  PubMed  Google Scholar 

  6. Tan-Kim J, Menefee SA, Lippmann Q, et al. A pilot study comparing anatomic failure after sacrocolpopexy with absorbable or permanent sutures for vaginal mesh attachment. Perm J. 2014;18:40–4. https://doi.org/10.7812/TPP/14-022.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nygaard IE, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104:805–23.

    Article  Google Scholar 

  8. Flynn MK, Romero AA, Amundsen CL, Weidner AC. Vascular anatomy of the presacral space: a fresh tissue cadaver dissection. Am J Obstet Gynecol. 2005;192:1501–5.

    Article  Google Scholar 

  9. Wieslander CK, Rahn DD, McIntire DD, et al. Vascular anatomy of the presacral space in unembalmed female cadavers. Am J Obstet Gynecol. 2006;195:1736–41.

    Article  Google Scholar 

  10. North CE, Ali-Ross NS, Smith AR, Reid FM. A prospective study of laparoscopic sacrocolpopexy for the management of pelvic organ prolapse. BJOG. 2009;116:1251–7.

    Article  CAS  Google Scholar 

  11. Ganatra AM, Rozet F, Sanchez-Salas R, et al. The current status of laparoscopic sacrocolpopexy: a review. Eur Urol. 2009;55:1089–103.

    Article  Google Scholar 

  12. Shiozawa T, Huebner M, Hirt B, Wallwiener D, Reisenauer C. Nerve-preserving sacrocolpopexy: anatomical study and surgical approach. Eur J Obstet Gynecol Reprod Biol. 2010;152:103–7.

    Article  Google Scholar 

  13. Baessler K, O’Neill SM, Maher CF, Battistutta D. A validated self-administered female pelvic floor questionnaire. Int Urogynecol J. 2010;21:163–72.

    Article  Google Scholar 

  14. Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C. A short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Int Urogynecol J. 2003;14:164–8.

    Article  Google Scholar 

  15. Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C. Erratum: a short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Int Urogynecol J. 2004;15:219.

    Article  Google Scholar 

  16. Wren PA, Janz NK, Brubaker L, et al. Reliability of health-related quality of life measures 1 year after surgical procedures for pelvic floor disorders. Am J Obstet Gynecol. 2005;192:780–8.

    Article  Google Scholar 

  17. Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–7.

    Article  CAS  Google Scholar 

  18. Blackwelder WC. Proving the null hypothesis in clinical trials. Control Clin Trials. 1982;3:345–53. https://doi.org/10.1016/0197-2456(82)90024-1.

    Article  CAS  PubMed  Google Scholar 

  19. Barbolt TA. Biology of polypropylene/polyglactin 910 grafts. Int Urogynecol J. 2006;17:26–30.

    Article  Google Scholar 

  20. North CE, Ali-Ross NS, Smith AR, Reid FM. A prospective study of laparoscopic sacrocolpopexy for the management of pelvic organ prolapse. BJOG. 2009;116:1251–7.

    Article  CAS  Google Scholar 

  21. Baessler K, Schuessler B. Abdominal sacrocolpopexy and anatomy and function of the posterior compartment. Obstet Gynecol. 2001;97:678–84.

    CAS  PubMed  Google Scholar 

  22. Fox SD, Stanton SL. Vault prolapse and rectocele: assessment of repair using sacrocolpopexy with mesh interposition. BJOG. 2000;107:1371–5.

    Article  CAS  Google Scholar 

  23. Forsgren C, Zetterström J, Zhang A, Iliadou A, Lopez A, Altman D. Anal incontinence and bowel dysfunction after sacrocolpopexy for vaginal vault prolapse. Int Urogynecol J. 2010;21:1079–84.

    Article  Google Scholar 

  24. Geomini PM, Brolmann HA, van Binsbergen NJ, Mol BW. Vaginal vault suspension by abdominal sacral colpopexy for prolapse: a follow up study of 40 patients. Eur J Obstet Gynecol Reprod Biol. 2001;94:234–8.

    Article  CAS  Google Scholar 

  25. Lefranc JP, Atallah D, Camatte S, Blondon J. Longterm followup of posthysterectomy vaginal vault prolapse abdominal repair: a report of 85 cases. J Am Coll Surg. 2002;195:352–8.

    Article  Google Scholar 

  26. Mauroy B, Demondion X, Drizenko A, et al. The inferior hypogastric plexus (pelvic plexus): its importance in neural preservation techniques. Surg Radiol Anat. 2003;25:6–15.

    Article  CAS  Google Scholar 

  27. Johnson RM, McGuire EJ. Urogenital complications of anterior approaches to the lumbar spine. Clin Orthopaed Relat Res. 1981;154:114–8.

    Google Scholar 

  28. Junginger T, Kneist W, Heintz A. Influence of identification and preservation of pelvic autonomic nerves in rectal cancer surgery on bladder dysfunction after total mesorectal excision. Dis Colon Rectum. 2003;46:621–8.

    Article  CAS  Google Scholar 

  29. Kneist W, Heintz A, Wolf HK, Junginger T. Identification of pelvic autonomic nerves during partial and total mesorectal excision—influence parameters and significance for neurogenic bladder. Chirurg. 2004;75:276–83.

    Article  CAS  Google Scholar 

  30. Kavvadias T, Schoenfisch B, Huebner M, Brucker SY, Wallwiener D, Reisenauer C. Perioperative adverse events associated with pelvic organ prolapse repair by nerve-preserving sacropexy: an analysis of 768 cases over a 10-year period. Arch Gynecol Obstet. 2018;298:353–61.

    Article  Google Scholar 

  31. Anand M, Woelk JL, Weaver AL, Trabuco EC, Klingele CJ, Gebhart JB. Perioperative complications of robotic sacrocolpopexy for post-hysterectomy vaginal vault prolapse. Int Urogynecol J. 2014;25:1193–200.

    Article  Google Scholar 

  32. Matthews CA. Minimally invasive sacrocolpopexy: how to avoid short- and long-term complications. Curr Urol Rep. 2016;17:81. https://doi.org/10.1007/s11934-016-0638-7.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Sabine Hahn, MD, for data collection and the gynecological examination of the study participants at the follow-up visits; Jacqueline Behrend, study nurse, for supporting the part of the study in Berlin; and Friederike Moroff for entering the data into the database.

Funding

The study was not funded.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany

    Christl Reisenauer, Jürgen Andress, Birgitt Schoenfisch, Markus Huebner & Sara Yvonne Brucker

  2. Women’s Center Bern, Bremgartenstrasse 117, 3001, Bern, Switzerland

    Markus Huebner

  3. Department of Urogynecology, German Pelvic Floor Centre, St. Hedwigs Hospital, Große Hamburger Straße 5–11, 10115, Berlin, Germany

    Andrea Lippkowski, Kathrin Beilecke, Juliane Marschke & Ralf Tunn

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  1. Christl Reisenauer
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Contributions

Christl Reisenauer: concept and design, analysis and interpretation of data, manuscript draft and revision; Juergen Andress: analysis and interpretation of data, manuscript draft; Birgitt Schoenfisch: concept and design, statistics, analysis and interpretation of data, manuscript revision; Markus Huebner: analysis and interpretation of data, manuscript revision; Sara Yvonne Brucker: concept and design, manuscript revision; Kathrin Beilecke: analysis and interpretation of data, manuscript draft; Andrea Lippkowski: analysis and interpretation of data, manuscript draft; Juliane Marschke: analysis and interpretation of data, manuscript draft; Ralf Tunn: concept and design, analysis and interpretation of data, manuscript revision.

Corresponding author

Correspondence to Christl Reisenauer.

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Conflicts of interest

Christl Reisenauer, Juergen Andress, Birgitt Schoenfisch: no conflicts of interest; Sara Y. Brucker: personal fees from Pfizer; Novartis, Teva, MSD, AstraZeneca, Storz, and Roche; Markus Huebner: consultant for Promedon GmbH; Andrea Lippkowski: grant from Promedon, support for German Pelvic Floor Center Berlin, personal fee from Coloplast; Kathrin Beilecke: grant from Promedon, support for the German Pelvic Floor Center Berlin; Juliane Marschke: grant from Promedon, support for the German Pelvic Floor Center Berlin; Ralf Tunn: grant from Promedon, support for the German Pelvic Floor Center Berlin.

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Reisenauer, C., Andress, J., Schoenfisch, B. et al. Absorbable versus non-absorbable sutures for vaginal mesh attachment during sacrocolpopexy: a randomized controlled trial. Int Urogynecol J 33, 411–419 (2022). https://doi.org/10.1007/s00192-021-04853-4

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