Device-free, Cost-effective Sacrospinous Fixation Using Absorbable versus Nonabsorbable Sutures: A 5-Year...

To evaluate the efficacy and safety of device-free concurrent sacrospinous fixation (SSF) performed at the time of vaginal hysterectomy using absorbable (polyglactin no. 1) versus nonabsorbable (polypropylene no. 1) sutures for preventing vaginal vault prolapse.

A prospective, comparative, cohort study included 185 women undergoing vaginal hysterectomy for pelvic organ prolapse (POP) stages II-IV from January 2016 to December 2018. Prophylactic SSF was performed in 90 patients using Polyglactin No. 1 sutures while in 95 patients using nonabsorbable sutures (Polypropylene No. 1). In both groups, Garg's technique was performed using Allis tissue forceps rather than a Capio device. Absorbable sutures (n = 90) were passed through the full thickness from sacrospinous ligament and tied to the vault while nonabsorbable sutures (n = 95) were placed submucosally in a double helix pattern and tied beneath the mucosa. The outcomes included anatomical success (POP-Q stage < II), recurrence rates, complications, and quality of life. Follow-up occurred at 1 month, 6 months, and annually for 5 years.

Anatomical success was achieved in 89/90 (98.9%) patients till 5 years with absorbable sutures, with a vault prolapse recurrence rate of 1.1% (1/90) versus 4.2% (4/95) with nonabsorbable sutures (P = 0.37). The complications included fever (1.1%) and urinary tract infection (UTI) (3.3%). No suture exposure or granuloma formation occurred with absorbable sutures, unlike 2.1% with nonabsorbable sutures (P = 0.50). Garg's technique reduced the cost by avoiding Capio device.

Concurrent sacrospinous fixation using Polyglactin no. 1 sutures with a simplified device-free technique demonstrated high long-term anatomical success rate and lower complication rates comparable to nonabsorbable sutures. This approach may be particularly useful in the resource-constrained settings.