Is Absorbable Suture Non-Inferior to Permanent Suture in Sacrospinous Ligament Suspension? A Randomized Controlled...

Sacrospinous ligament suspension (SSLS) is a common native-tissue prolapse repair procedure. Although effective, 5-year failure rates can approach 70%. Permanent sutures offer durability but carry risks such as erosion and bleeding. Absorbable sutures may reduce these complications, but their efficacy remains uncertain. We hypothesized that absorbable sutures would be non-inferior to permanent sutures in maintaining apical support at 12 months.

We conducted a randomized controlled trial from January 2023 to January 2025 at a tertiary center. Patients undergoing SSLS were randomized 1:1 to absorbable or permanent sutures. Blinded assessors evaluated outcomes. The primary outcome was POP-Q point C at 12 months. A non-inferiority margin of 2 points in POP-Q point C and standard deviation of 2 were used. Secondary outcomes included composite prolapse recurrence, suture-related complications, and Patient Global Impression of Improvement (PGI-I). To achieve 90% power with α = 0.05, 18 patients per group were required. Fisher's exact, Mann-Whitney U, and Chi-squared tests were used where appropriate.

Forty-nine patients were randomized; 41 completed follow-up (23 absorbable, 18 permanent). Median point C was -5 in both groups (p = 0.98). Composite recurrence rates were similar (43.5% absorbable vs 50% permanent, p = 0.68). No suture erosion or granulation was observed. PGI-I improvement in 82.6% of the absorbable and 100% of the permanent group (p = 0.12).

Absorbable sutures were non-inferior to permanent sutures in supporting apical prolapse at 12 months. Both groups demonstrated high rates of patient-reported improvement with low complication rates.