A randomized controlled trial of permanent vs absorbable suture for uterosacral ligament suspension

Uterosacral ligament suspension (USLS) is a common procedure for apical pelvic organ prolapse. The procedure has been described using only permanent suture, only absorbable suture and a combination of permanent and absorbable suture. We hypothesized that the use of absorbable suture is not inferior to the use of permanent suture.

All women undergoing USLS between October 2016 and November 2017 were approached. Subjects were randomized to permanent or absorbable suture. The primary outcome was POP-Q point C 12 months after surgery (non-inferiority limit = 2 cm). A composite outcome of success at 12 months was defined as no apical prolapse ≥ 1/2 TVL, no prolapse beyond the hymen, no prolapse retreatment and no bulge symptoms.

Forty-four subjects with mean (SD) age 62.9 (12.0) years and body mass index 29.1 (5.4) kg/m² were enrolled and underwent USLS. Fifteen (34.1%) had POP-Q stage II and 29 (65.9%) stage III prolapse. Twenty-two were randomized to permanent and 22 to absorbable suture. Forty (90.9%) completed the 12-month follow-up. Median (IQR) POP-Q point C at 12 months was -7 (-10, -6) for the permanent and - 7 (-9, -5.5) for the absorbable suture groups (p = 0.65, non-inferiority p < 0.0002). Four (20%) in the permanent and one (5%) in the absorbable suture group reported bulge symptoms (p = 0.34). Fifteen (75%) in the permanent and 18 (90%) in the absorbable suture groups met criteria for composite success (p = 0.41). Intervention-related adverse outcomes were uncommon and not different between groups.

Absorbable suture for USLS is not inferior to permanent suture for apical anatomic outcomes.