Ten-Year Outcomes After Nerve-Preserving Sacrocolpopexy for Vaginal Vault Suspension Using Resorbable Versus Nonresorbable Sutures

Abstract Introduction and Hypothesis Sacrocolpopexy (SCP) is the preferred treatment for vaginal vault prolapse. Long-term evidence comparing absorbable versus non-absorbable sutures for vaginal mesh fixation and functional outcomes after nerve-preserving SCP is lacking. Methods In this bicentric, prospective, randomized trial, women with vaginal vault prolapse (Pelvic Organ Prolapse Quantification [POP-Q] stage II–III) underwent laparoscopic nerve-preserving SCP with either resorbable (VIC) or nonresorbable (ETH) sutures for vaginal mesh fixation. Concomitant surgeries were not permitted. Whereas the previous report focused on 6-month outcomes, the current analysis extends follow-up to 10 years. Primary outcome was anatomical success (POP-Q); secondary outcomes were functional outcomes assessed with validated questionnaires. Suture or mesh erosion and late adverse events were recorded. Results Ten-year data were available for 104 of the 195 women. After a median of 10.2 years (range, 9.2–12.8), 102 women had POP-Q stage 0 and 2 had stage I in the apical compartment, with no difference between the groups. Two women were excluded owing to surgery for recurrence. Functional outcomes improved postoperatively and remained improved 10 years later. Three vaginal suture penetrations and one vaginal mesh erosion in the ETH group were asymptomatic; two vaginal mesh erosions in the VIC group required excision. Four anterior (1 ETH, 3 VIC) and six posterior colporrhaphies (3 ETH, 3 VIC) were performed. Nine women received a TVT and 1 a retropubic colposuspension; 1 small vesico-vaginal fistula was detected (ETH). Conclusions Resorbable sutures were not observed to be inferior to nonresorbable sutures for vaginal mesh fixation during SCP. Nerve-preserving SCP was associated with a reduction in defecation disorders.