110 Long term follow up on barbed sutures in sacrocolpopexy

Abstract

Apical pelvic organ prolapse (POP) is conventionally managed with abdominal sacrocolpopexy (SCP). However, due to its associated morbidities and longer recovery times, a minimally invasive approach via robotic-assisted sacrocolpopexy (RSCP) is gaining popularity with success rates of 87-100%. In addition, self-anchoring barbed sutures (SABs) has been introduced of suturing Y- shaped vaginal mesh in RSCP. This avoids knot tying with less time and aggravation. In our study, we demonstrated the long-term anatomical success and reoperation rates with SABs in RSCP. Under an IRB-approved protocol (IRB #19-0167), we retrospectively reviewed patients with symptomatic stage 2 or higher POP based on the Pelvic Organ Prolapse Quantification system (POP-Q) who underwent RSCP at a tertiary care academic medical center from January 2016 to October 2017. The placement of the Y-shaped vaginal mesh with 3-0 V Loc was consistent across all surgeries and performed by the same surgeon. Follow-up examinations were performed at intervals up to two years. Postoperative POP-Q scores <0 indicate anatomical correction without prolapse symptoms. Baseline demographics of patients were summarized by frequencies and percentages for categorical variables and by mean/median, standard deviation, and ranges for continuous variables. Descriptive univariate statistics were performed by SPSS Statistics. Fifty-five patients underwent RSCP with the mean age of 59.3 years. Seventeen patients were lost to follow-up and were excluded from the study. Of the 38 patients, the POP-Q system classified 28.9% with stage 2, 63.2% with stage 3 and 5.3% with stage 4 POP at baseline. A history of prior hysterectomy was noted in 55.3% of the patients and 31.6% of patients had a previous POP surgery. In our study, 42.1% underwent a hysterectomy with SCP, 18.4% a Burch urethropexy with SCP, 44.7 % a midurethral sling with SCP, and 5.3% of the patients solely underwent a sacrocolpopexy with no cases converted to open surgery. Our patients had an anatomical success rate of 86.8% with no mesh erosion on the 2-year postoperative follow-up. The complication rate was 7.9% due to intraoperative bladder injuries and were repaired primarily. Three patients had stage 2 prolapse and two patients had stage 3 prolapse on follow-up with a reoperation rate of 10.5%. of Our study suggests using RSCP with 3-0 SABs for vaginal wall mesh fixation as a favorable management for POP with low perioperative complication and reoperation rates.View Large Image Figure ViewerDownload Hi-res image Download (PPT)