Abstract
Introduction and hypothesis
We aimed to assess the pull-out strength of barbed and nonbarbed sutures used in sacrocolpopexy mesh fixation. We hypothesized there are no differences in the force needed to dislodge mesh from tissue using barbed and nonbarbed sutures of similar size.
Methods
Using the rectus fascia of three unembalmed cadavers, a 6 × 3 cm strip of polypropylene mesh was anchored to the fascia with sutures. The barbed sutures investigated were 2-0 V-Loc 180 (nine trials) and 3-0 bidirectional Quill™ SRS PDO (five trials). The nonbarbed sutures included 2-0 PDS (nine trials), CV-2 GORE-TEX (nine trials) and 2-0 Prolene (nine trials). The free-end of the mesh was anchored to a pulley system fixed to a tensiometer to measure the peak force applied at the moment of mesh dislodgement (termed the pull-out force). The pull-out force was recorded. Continuous variables are presented as medians and interquartile ranges (IQR). Analysis of variance was used to compare the forces across the suture types.
Results
The highest pull-out force observed was with GORE-TEX (median 65.14 N, IQR 53.37–68.77 N) followed by Prolene (median 58.98 N, IQR 54.64–62.59 N), V-Loc (median 55.23 N, IQR 51.60–58.57 N), PDS (53.96 N, IQR 51.60–57.88 N), and Quill (44.44 N, IQR 17.27–47.38 N). All 2-0 and CV-2 caliber sutures had greater pull-out forces than 3-0 Quill sutures (p < 0.01). No significant differences in pull-out forces were observed between 2-0 and CV-2 caliber sutures (p > 0.05). In 35 of the 41 trials (85%), the mesh sheared from the tissue.
Conclusion
CV-2 ad 2-0 barbed and nonbarbed sutures had similar pull-out forces in an assessment of mesh fixation strength.
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Acknowledgements
The authors thank Professor Steven Campolo for technical support, and hel** design and fabricating the mesh clamp and pulleys. We gratefully acknowledge the contribution of the Northwell Health Bioskills Education Center for their facilities and support staff.
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P.S.F. is a consultant for Boston Scientific and received honorarium. H.A.W. is a consultant for Kimberly-Clark and Boston Scientific, and received honorarium.
The other authors report no conflicts of interest.
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Pilkinton, M.L., Levine, G.C., Bennett, L. et al. Comparison of strength of sacrocolpopexy mesh attachment using barbed and nonbarbed sutures. Int Urogynecol J 29, 153–159 (2018). https://doi.org/10.1007/s00192-017-3451-z
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DOI: https://doi.org/10.1007/s00192-017-3451-z