Impact of Permanent versus Absorbable Suture in Sacrocolpopexy for Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

2022

Journal Title

International Urogynecology Journal

Department

Anesthesiology

Second Department

Obstetrics and Gynecology

Abstract

Introduction: Sacrocolpopexies are commonly performed surgeries for apical vaginal prolapse. Either permanent or absorbable sutures are used at the discretion of the surgeon. There is limited data comparing the outcomes of permanent and absorbable sutures used during sacrocolpopexy. Our study focuses on the anatomic outcomes of permanent versus absorbable suture use on the vaginal mesh attachment in sacrocolpopexy. Objective: To systematically review the literature regarding how permanent versus absorbable suture impacts anatomic failure in women undergoing sacrocolpopexy. Methods: MEDLINE and EMBASE were searched from their inception through 6/11/21 using pre-identified search terms. Our population included studies of women who underwent sacrocolpopexy. We excluded cadaver, tissue sample, or animal studies. We excluded hysteropexy. Our intervention was defined as permanent sutures (polytetrafluoroethylene, polypropylene, poliglecaprone 25, polyester, silk, and nylon). Our comparator group was absorbable or delayed absorbable sutures (polyglactin, polydiaxanone, and polyglyconate). Outcomes included anatomic failure defined using POP-Q stage or Baden Walker grade, subjective symptoms of a bulge, re-operations, or re- treatments. A single composite anatomic success proportion was determined for each study. Adverse events including suture exposure, mesh exposure, granulation tissue, surgery for suture complication, and dyspareunia were collected. Abstracts were double-screened using Abstrackr, then full text articles were doubly screened, and then accepted articles were doubly extracted. Quality of studies was assessed using GRADE criteria. In studies using either absorbable or permanent sutures (singlearm studies), random effects meta-analyses of pooled proportions were used to assess anatomic success. In studies investigating both suture types (comparative studies), random effect meta-analyses of pooled risk ratios were used. Analyses were performed using STATA, v.17 and p<=0.05 was considered statistically significant. Results: 4,357 abstracts were screened, 349 full-text papers assessed, and 41 studies met eligibility criteria. (Figure 1). Of these, 7 compared both suture types, and 34 used one suture type. Overall, 11 studies were RCTs, 12 were comparative (1 prospective and 11 retrospective) and 17 were single arm (8 prospective, 9 retrospective, 1 unclear direction). 4 studies had quality ratings of A, 18 were rated B, and 19 were C. Mean follow up was 17.4 months. The proportional anatomic success rate of absorbable suture (n=13) was 90% (95% CI 0.86, 0.94), and permanent suture (n=24) was 93% (95% CI 0.91, 0.95) with considerable heterogeneity. On meta-analysis, there was no difference in relative risk of success compared to failure for permanent sutures versus absorbable sutures (n=7), RR = 1.01 (95% CI 0.99, 1.02) with low heterogeneity (Figure 2). Conclusions: Overall, failure rate was low and similar for both absorbable and permanent suture for the vaginal attachment of sacrocolpopexy with medium term follow-up.

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