The mesh fixation dilemma in robotic sacrocolpopexy: Absorbable or non-absorbable sutures? Insights from a high-volume observational cohort.

Abstract

<h4>Introduction</h4>Limited evidence has been reported on the results of robot-assisted sacrocolpopexy (RASC) related to the type of sutures used.<h4>Objective</h4>The objective of this study is to analyze the results comparing absorbable with non-absorbable sutures. The primary outcome was mesh related complications and secondary outcomes were anatomical success, early complications and patient satisfaction.<h4>Methods</h4>A prospective, comparative study for the first 123 RASC surgeries performed between December 2016 and June 2022. All patients who underwent robotic sacrocolpopexy were included. No exclusion criteria were established. The procedures were performed by surgeon "A" who used non-absorbable sutures and surgeon "B" who used absorbable sutures. Patient data was collected at baseline, intraoperatively, as well as reporting early complications and mesh-related complications. Anatomic recurrence was defined as patients with POP ≥ 2 on the Baden-Walker scale while the sensation of vaginal bulge determined subjective failure.<h4>Results</h4>Non-absorbable sutures were used in 55.3% of the patients while absorbable sutures were used in 44.7% of the patients. The mean follow-up was longer in the absorbable suture group (21.5 vs. 35.3 p < 0.01). No statistically significant differences were found in mesh-complication rate (4.4% vs. 0%, p = 0.16) and in anatomical recurrence and subjective (4.4% vs. 9.1%, p = 0.24). The main limitation of our study was the absence of randomization.<h4>Conclusions</h4>The type of suture used for mesh fixation in RASC does not influence the anatomical outcomes, early complications or mesh-related complications.