New York Medical College, and the Departments of Obstetrics and Gynecology, Urology, and Pharmacology, and the Department of Public Health, School of Health Sciences and Practice, New York Medical College, Hawthorne, New York.
Obstet Gynecol. 2023 Feb 1;141(2):268-283. doi: 10.1097/AOG.0000000000005032. Epub 2023 Jan 4.
To explore how permanent compared with absorbable suture affects anatomic success in native tissue vaginal suspension (uterosacral ligament suspension and sacrospinous ligament suspension) and sacrocolpopexy with mesh.
MEDLINE, EMBASE, and ClinicalTrials.gov were searched through March 29, 2022.
Our population included women undergoing apical prolapse surgery (uterosacral ligament suspension and sacrospinous ligament suspension and abdominal sacrocolpopexy). Our intervention was permanent suture for apical prolapse surgery, and our comparator was absorbable suture. We determined a single anatomic success proportion per study. Adverse events collected included suture and mesh exposure, surgery for suture and mesh complication, dyspareunia, and granulation tissue. Abstracts were doubly screened, full-text articles were doubly screened, and accepted articles were doubly extracted. Quality of studies was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. In single-arm studies using either permanent or absorbable suture, random effects meta-analyses of pooled proportions were used to assess anatomic success. In comparative studies investigating both suture types, random effects meta-analyses of pooled risk ratios were used.
TABULATION, INTEGRATION, AND RESULTS: Of 4,658 abstracts screened, 398 full-text articles were assessed and 63 studies were included (24 vaginal suspension [13 uterosacral ligament suspension and 11 sacrospinous ligament suspension] and 39 sacrocolpopexy). At 2-year follow-up, there was no difference in permanent compared with absorbable suture in uterosacral ligament suspension and sacrospinous ligament suspension (proportional anatomic success rate 88% [95% CI 0.81-0.93] vs 88% [95% CI 0.82-0.92]). Similarly, at 18-month follow-up, there was no difference in permanent compared with absorbable suture in sacrocolpopexy (proportional anatomic success rate 92% [95% CI 0.88-0.95] vs 96% [95% CI 0.92-0.99]). On meta-analysis, there was no difference in relative risk (RR) of success for permanent compared with absorbable suture for uterosacral ligament suspension and sacrospinous ligament suspension (RR 1.11, 95% CI 0.93-1.33) or sacrocolpopexy (RR 1.00, 95% CI0.98-1.03).
Success rates were similarly high for absorbable and permanent suture after uterosacral ligament suspension, sacrospinous ligament suspension, and sacrocolpopexy, with medium-term follow-up.
PROSPERO, CRD42021265848.
探讨永久性缝线与可吸收缝线在 native tissue vaginal suspension（子宫骶骨韧带悬吊术和骶棘韧带悬吊术）和 sacrocolpopexy 加网片固定中的解剖学成功率方面的差异。
通过 2022 年 3 月 29 日检索 MEDLINE、EMBASE 和 ClinicalTrials.gov。
我们的研究人群包括接受穹窿脱垂手术（子宫骶骨韧带悬吊术和骶棘韧带悬吊术和腹式骶骨阴道固定术）的女性。我们的干预措施是穹窿脱垂手术中的永久性缝线，对照组为可吸收缝线。我们每篇研究确定了一个单一的解剖学成功率比例。收集的不良事件包括缝线和网片暴露、缝线和网片并发症的手术、性交困难和肉芽组织。对摘要进行了双重筛选，对全文进行了双重筛选，并对接受的文章进行了双重提取。使用 GRADE（推荐评估、制定和评估分级）标准评估研究质量。在使用永久性或可吸收缝线的单臂研究中，使用汇总比例的随机效应荟萃分析评估解剖学成功率。在同时比较两种缝线类型的研究中，使用汇总风险比的随机效应荟萃分析。
在筛选出的 4658 篇摘要中，有 398 篇全文文章进行了评估，共有 63 项研究纳入（24 项阴道悬吊术[13 项子宫骶骨韧带悬吊术和 11 项骶棘韧带悬吊术]和 39 项骶骨阴道固定术）。在 2 年随访时，子宫骶骨韧带悬吊术和骶棘韧带悬吊术中永久性缝线与可吸收缝线相比，解剖学成功率无差异（比例解剖学成功率 88%[95%CI 0.81-0.93] vs 88%[95%CI 0.82-0.92]）。同样，在 18 个月随访时，在 sacrocolpopexy 中，永久性缝线与可吸收缝线的解剖学成功率也无差异（比例解剖学成功率 92%[95%CI 0.88-0.95] vs 96%[95%CI 0.92-0.99]）。荟萃分析显示，在子宫骶骨韧带悬吊术和骶棘韧带悬吊术或骶骨阴道固定术（RR 1.11，95%CI 0.93-1.33）中，永久性缝线与可吸收缝线相比，成功率的相对风险（RR）无差异。
在子宫骶骨韧带悬吊术、骶棘韧带悬吊术和骶骨阴道固定术加网片固定后，可吸收缝线和永久性缝线的成功率均较高，随访时间为中期。
PROSPERO，CRD42021265848。
