Comparing Choice of Suture for Myoma Bed Closure in Abdominal Myomectomy

INTRODUCTION: Historically, Vicryl (a smooth, synthetic, absorbable suture) has been the primary suture type to close uterine defects in abdominal myomectomies. V-loc, a unidirectional, barbed suture, has been adopted as an alternative and has been shown to be safe and effective in gynecologic surgery. As V-loc does not require knot-tying and has the ability to hold itself in place due to its barbed nature, it has been shown to improve the speed of suturing in addition to reduce blood loss. OBJECTIVE: To identify differences in complications with use of Vicryl versus V-loc to close myoma beds at the time of abdominal myomectomy. METHODS: Abdominal myomectomy cases performed at a single, tertiary care, academic medical center from 2019 to 2023 were identified using administrative data by searching “abdominal” and “myomectomy” in procedure description. Surgeries that included secondary procedures that might contribute to increased blood loss, including hysterectomy, cystectomy, other mass removal, hysteroscopic polypectomy or myomectomy, salpingectomy, or confirmed cancer, were excluded. Patients were categorized as having their myoma bed closed with V-loc if there were charges for at least two stitches. All other surgeries were classified as using Vicryl. Surgeon, date of birth, total operative time, estimated blood loss, and tobacco use were electronically extracted from the administrative database. This was supplemented with a medical record review to obtain demographics and other clinical data. The primary outcome was a composite of postoperative complications: blood transfusion, infection, ileus or small bowel obstruction, unscheduled postoperative visit, emergency department presentation, and hospital readmission. Data are presented as n (%), mean ± standard deviation, or median and interquartile range (IQR). Generalized estimating equations were used to calculate risk ratios (RR) and 95% confidence intervals for the association between V-loc suture use and adverse outcomes, adjusting for within-surgeon correlation and ASA score. RESULTS: A total of 171 cases (118 Vicryl and 53 V-loc) were included in the final analysis. Age and body mass index were similar between groups. Patients in the Vicryl group were more likely to be White and had lower ASA scores. There were also differences in use of anticoagulation and smoking (Table 1). The median number of fibroids removed was 8 (IQR 4–17) and 11 (IQR 4–18) in the Vicryl compared to V-loc group, respectively. The median specimen weight was 426.0 (IQR 242.0–767.0) grams compared to 537.0 (IQR 340.0–900.0) grams in the Vicryl compared to V-loc group. After adjusting for ASA score and surgeon, there was no significant association between V-loc suture use and adverse outcomes, RR 1.43 (95% CI: 0.84, 2.42). Total operative time was significantly lower in the Vicryl group compared to the V-loc group (179.4±58.5 minutes vs. 215.1±75.9 minutes, p=0.003). CONCLUSIONS: There was no significant association between suture type and adverse outcomes in abdominal myomectomy cases. However, our data suggests that cases that used V-loc had a larger number of fibroids removed and heavier specimen weight, suggesting that V-loc may be used in more complex abdominal myomectomy cases with larger anticipated blood loss, an area for future research studies (Table 2).