Barbed Suture Strength in Sacrocolpopexy: Does Pattern Matter?

Although barbed suture in sacrocolpopexy is becoming increasingly common, an accepted vaginal attachment pattern for barbed suture has not been established.

This study aimed to compare the structural properties of 3 different barbed suture attachment patterns used to fixate mesh to the vagina during sacrocolpopexy.

Segments of type 1 polypropylene mesh (Restorelle; Coloplast, Humlebaek, Denmark) measuring 6 × 3 cm were affixed to rectus abdominis fascia from 5 fresh-frozen female cadavers. Barbed 6-inch 2-0 polydioxanone (Stratafix; Ethicon, Raritan, NJ) with 3 different attachment patterns and nonbarbed 2-0 polydioxanone were used for fixation. Barbed suture attachment patterns included circular, horizontal, and vertical patterns. Mechanical testing was carried out using a uniaxial tensile test to failure.

Tensile testing resulted in similar mechanical properties across all suture attachment pattern groups. Analyses found no significant effect of suture attachment pattern stiffness or the extension at failure. One-way ANOVAs revealed a global effect of suture attachment pattern on the load at failure ( P  = 0.0188) and energy at failure ( P  = 0.0435), but this significance was eliminated after controlling for multiple comparisons. A significant ( P  = 0.0459) increase in ultimate load was found when comparing the horizontal attachment pattern to the vertical attachment pattern.

No difference was observed when comparing suture attachment patterns (circular, horizontal, and vertical). However, a statistically significant difference in ultimate load favored the horizontal attachment over the vertical attachment. Furthermore, there was no difference observed when comparing nonbarbed interrupted suture attachment to the 3 barbed suture attachment patterns.