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Sacral mesh pullout strength based on suture location for sacrocolpopexy
Stuart Shippey1, Edward Sutter, Stephen M Belkoff
1Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, VA 23708-2197, USA. stuart.shippey@med.navy.mil
Gynecologic and Obstetric Investigation
|July 5, 2012
Summary
Sacrocolpopexy mesh has stronger suture pullout strength when attached to the first sacral vertebral level (S1) compared to the second (S2). This finding is crucial for pelvic reconstructive surgery outcomes.
Area of Science:
- Urogynecology
- Pelvic Reconstructive Surgery
- Biomechanical Analysis
Background:
- Sacrocolpopexy is a surgical procedure to treat pelvic organ prolapse.
- The method of mesh attachment to the sacrum can influence surgical outcomes.
- Comparing fixation points is essential for optimizing surgical techniques.
Purpose of the Study:
- To compare the biomechanical pullout strength of sacrocolpopexy mesh fixation at the first sacral vertebral level (S1) versus the second sacral vertebral level (S2).
Main Methods:
- Nine unembalmed female cadaveric pelvises were used.
- Polypropylene mesh segments were attached to the sacrum at S1 or S2 using sutures.
- Suture pullout strength was measured by pulling the mesh at a constant rate until system failure.
Main Results:
- System failure typically occurred at the suture attachment point to the anterior longitudinal ligament.
- Median pullout strength at S1 was 7.49 lb (IQR 7.95).
- Median pullout strength at S2 was 3.15 lb (IQR 2.975), significantly lower than S1 (p = 0.028).
Conclusions:
- Suture fixation of sacrocolpopexy mesh to the sacrum demonstrates significantly greater pullout strength at the S1 level compared to the S2 level.
- These findings suggest S1 may be a more robust fixation site for pelvic reconstructive surgery.
