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

Area of Science:

• Gynecology
• Urogynecology
• Surgical Innovation

Background:

• Vaginal vault prolapse is a common complication after hysterectomy.
• Sacrospinous fixation (SSF) is a surgical technique to prevent prolapse.
• Device-free techniques may offer cost and accessibility benefits.

Purpose of the Study:

• To compare the efficacy and safety of device-free concurrent sacrospinous fixation (SSF) using absorbable versus nonabsorbable sutures during vaginal hysterectomy.
• To evaluate the long-term outcomes, including anatomical success and complication rates.

Main Methods:

• A prospective, comparative cohort study of 185 women undergoing vaginal hysterectomy for pelvic organ prolapse (POP) stages II-IV.
• Patients received prophylactic SSF using either Polyglactin No. 1 (absorbable, n=90) or Polypropylene No. 1 (nonabsorbable, n=95) sutures via Garg's device-free technique.
• Outcomes assessed included anatomical success (POP-Q stage < II), recurrence, complications, and quality of life over 5 years.

Main Results:

• High anatomical success rates were observed: 98.9% with absorbable sutures vs. 95.8% with nonabsorbable sutures (P=0.37).
• Recurrence rates were low: 1.1% for absorbable vs. 4.2% for nonabsorbable sutures.
• Complications like fever and UTI were comparable; absorbable sutures had no exposure or granuloma issues, unlike nonabsorbable sutures (2.1%).

Conclusions:

• Device-free concurrent SSF with absorbable sutures achieves high long-term anatomical success and comparable safety to nonabsorbable sutures.
• This simplified, cost-effective approach is suitable for resource-constrained settings.
• Garg's device-free technique for SSF reduces costs by eliminating the need for specialized devices.