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A Comparative Evaluation of Double Versus Loop Suture Techniques in Sacrospinous Ligament Fixation Over Two Years
Ayşe Betül Albayrak Denizli1, Eralp Bulutlar2, Gizem Berfin Uluutku Bulutlar3
1Department of Obstetrics and Gynecology, University of Health Sciences Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Burhanettin Ustunel Cd., 34668, Istanbul, Turkey. abetulalbayrak@gmail.com.
Introduction And Hypothesis:
Sacrospinous ligament fixation (SSF) is a widely accepted native tissue technique for apical pelvic organ prolapse (POP), especially following the decline in mesh-based procedures. However, the optimal suture technique remains under debate.
Objectives:
To compare the clinical outcomes of double versus loop suture techniques in SSF, with a focus on operative efficiency, complications, recurrence, and reoperation rates over a 24-month follow-up.
Patients And Methods:
This retrospective cohort study included 195 patients with stage 3 or 4 POP who underwent SSF with nonabsorbable polypropylene suture between January 2020 and January 2023 in a tertiary-care academic hospital specializing in urogynecologic surgery. Group 1 (n = 115) underwent classical double suture SSF, while group 2 (n = 80) received the loop suture technique. Demographic characteristics, operative times, perioperative complications, recurrence, and reoperation rates were recorded and compared between the groups.
Main Outcome Measures:
Primary outcomes were total operative time. Secondary outcomes included postoperative complications such as gluteal pain, recurrence rate, and reoperation rate.
Results:
Both groups were similar in age, BMI, and baseline POP stage. The loop suture group had significantly shorter total operative time (154.04 ± 41.83 vs. 112.85 ± 37.34 min, p < 0.001) and SSF-specific surgical time (59.09 ± 22.97 vs. 37.34 ± 10.91 min, p < 0.001). Although recurrence rates were similar (24.3% in the double suture group vs. 18.7% in the loop suture group, p = 0.452), reoperation was significantly less frequent in the loop group (5% vs. 14.7%, p = 0.035). Gluteal pain occurred more often in the double suture group, although these differences were not statistically significant.
Conclusion:
The loop suture technique appears to be a safe and efficient alternative to the classical double suture method for SSF, offering reduced operative time and lower reoperation rates without compromising effectiveness.
