Pattern of suture use for pelvic organ prolapse surgery

Abstract

Permanent and delayed suture types may be similar in anatomic outcomes after surgical correction of pelvic organ prolapse; however, surgeon preference could vary. A survey investigating the practice patterns of suture use in female pelvic reconstructive surgery was conducted. An IRB-approved survey was distributed through the Society of Gynecologic Surgeons by a link via email to 278 members and shared on Twitter using #gynecologic surgery, @FPMRS, @Gyn Surgery, and @iugaoffice. Surgeon demographics and suture preference for various pelvic organ prolapse surgeries was queried with 36 questions. Responses were analyzed with descriptive statistics. We received 110/278 (40%) responses from surgeons including 86% urogynecologists, 6% Ob/Gyn, and 8% other. 47% were male, and 52% female. 20% of respondents were 0-4 years in practice, 21% were 5-9 years, 15% 10-15, years 12% 16-20 years, and 33% were >20 years in practice. Most respondents were academically affiliated (73%), whereas 10% were in hospital practice and 15% were in private practice. Most respondents perform >50 prolapse surgeries per year (76%) and 6% perform <20. The majority (99%) were Ob Gyn trained vs Urology trained (1%) and 80% are board certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). The types of sutures used varied between the different surgeries (Table 1). Some surgeries had a strong suture preference among surgeons, with 88% of surgeons preferring to use permanent sutures for sacral attachment during sacrocolpopexy, and 56% using delayed absorbable for the vaginal attachment. Delayed absorbable suture was the most common preference for uterosacral ligament suspension (USLS) 54%, and sacrospinous ligament fixation (SSLF) 54%. There was greater disparity in responses regarding suture preference for anterior colporrhaphy, posterior colporrhaphy, and colpocleisis; however, most surgeons reported a preference for absorbable (38-46%) or delayed absorbable suture (32-49%). In this group of predominantly gynecology trained FPMRS surgeons in SGS, there was a strong preference for permanent suture for the sacral attachment for sacrocolpopexy and delayed absorbable for the vaginal attachment. Delayed absorbable suture was also the preference for apical sutures for USLS and SSLF. We acknowledge limitations of small sample size; however, we did query highly trained, high volume surgeons. Our next step is to expand this survey to capture more respondents.