Surgical Outcomes of Permanent Versus Absorbable Suture Use in Sacrospinous Ligament Suspension

INTRODUCTION: One in eight women will seek surgical correction of pelvic organ prolapse (POP). Sacrospinous ligament suspension (SSLS) of the uterus or vaginal vault addresses apical POP. There is a paucity of safety and surgical outcomes data to guide SSLS suture selection (permanent vs non-permanent) and best surgical practice. OBJECTIVE: To examine safety and surgical outcomes data for SSLS across suture materials, comparing absorbable, permanent, and a combination of both. METHODS: A retrospective cohort study was performed using data from an established registry of patients undergoing apical POP repair at two Canadian hospitals between July 2020 and November 2022. We performed a chart review for all registry participants who underwent SSLS to determine SSLS suture material used. Participants were categorized into three groups: i) Prolene only (SSLS-P), ii) Vicryl only (SSLS-V), and iii) combination of Prolene and Vicryl (SSLS-C). Our primary outcome was the rate of anatomic apical prolapse recurrence at 1 year postoperatively, defined by descent of point C ≥ 50% of total vaginal length (TVL). Secondary outcomes included patient-reported POP symptoms, composite POP recurrence (stage ≥2 POP in any compartment on examination 1 year postoperatively), and re-presentation to healthcare for postoperative concerns, including need for re-operation to address SSLS-specific complications (ex., nerve entrapment). RESULTS: Of the 86 participants who underwent SSLS, 37 received SSLS-P; 12 received SSLS-V; 37 received SSLS-C. Forty-eight patients returned for 1-year follow-up (attrition was equal across groups). There were no significant differences in age, BMI, smoking status, parity, or preoperative POP staging. Anatomic apical POP recurrence occurred exclusively in the SSLS-C group (SSLS-P n=0/17 [0%], SSLS-V n=0/8 [0%], SSLS-C: n=6/23 [26.1%]; p=0.035). The SSLS-C group was more likely to have had a concurrent hysterectomy (SSLS-C: n=10/37 [27.0%], SSLS-P: n=1/37 [2.7%], SSLS-V: n=2/12 [16.7%]) and less likely to have had a vaginal uterine suspension via SSLS (SSLS-C: n=24/37 [64.9%], SSLS-P: n=32/37 [86.5%], SSLS-V: n=9/12 [75.0%]); p=0.048. Composite and subjective POP recurrence did not differ between groups. Suture material did not significantly impact post-op opioid use, SSLS suture-related pain, or rate of re-presentation to care. No participants required re-operation for SSLS-specific complications. CONCLUSIONS: In participants undergoing SSLS-C, there was a statistically significant increase in anatomic apical prolapse recurrence compared to SSLS-V and SSLS-P. There did not appear to be a significant association between suture type and complications such as reoperation rate, return to ED, and postoperative pain. The study was limited by its retrospective nature and small sample size.