Device-free, Cost-effective Sacrospinous Fixation Using Absorbable versus Nonabsorbable Sutures: A 5-Year Prospective, Cohort Study.

OBJECTIVE

To evaluate the efficacy and safety of device-free concurrent sacrospinous fixation (SSF) performed at the time of vaginal hysterectomy using absorbable (polyglactin no. 1) versus nonabsorbable (polypropylene no. 1) sutures for preventing vaginal vault prolapse.

MATERIALS AND

METHODS

A prospective, comparative, cohort study included 185 women undergoing vaginal hysterectomy for pelvic organ prolapse (POP) stages II-IV from January 2016 to December 2018. Prophylactic SSF was performed in 90 patients using Polyglactin No. 1 sutures while in 95 patients using nonabsorbable sutures (Polypropylene No. 1). In both groups, Garg's technique was performed using Allis tissue forceps rather than a Capio device. Absorbable sutures (n = 90) were passed through the full thickness from sacrospinous ligament and tied to the vault while nonabsorbable sutures (n = 95) were placed submucosally in a double helix pattern and tied beneath the mucosa. The outcomes included anatomical success (POP-Q stage < II), recurrence rates, complications, and quality of life. Follow-up occurred at 1 month, 6 months, and annually for 5 years.

RESULTS

Anatomical success was achieved in 89/90 (98.9%) patients till 5 years with absorbable sutures, with a vault prolapse recurrence rate of 1.1% (1/90) versus 4.2% (4/95) with nonabsorbable sutures (P = 0.37). The complications included fever (1.1%) and urinary tract infection (UTI) (3.3%). No suture exposure or granuloma formation occurred with absorbable sutures, unlike 2.1% with nonabsorbable sutures (P = 0.50). Garg's technique reduced the cost by avoiding Capio device.

CONCLUSION

Concurrent sacrospinous fixation using Polyglactin no. 1 sutures with a simplified device-free technique demonstrated high long-term anatomical success rate and lower complication rates comparable to nonabsorbable sutures. This approach may be particularly useful in the resource-constrained settings.