Anterior colpotomy closure: do suture and stitching technique matter?

Balzarro M1, Rubilotta E1, Serati M2, Li Marzi V3, Frigerio M4, Serni S3, Mancini V5, Carrieri G5, Saleh O6, Torrazzina M7, Malanowska E8, Starczewski A8, Braga A9, Trabacchin N1, Antonelli A1

Research Type

Clinical

Abstract Category

Pelvic Organ Prolapse

Abstract 62
Prolapse
Scientific Podium Short Oral Session 6
Friday 20th November 2020
11:30 - 11:37
Brasilia 2
Pelvic Organ Prolapse Stress Urinary Incontinence Surgery Female
1. A.O.U.I. Verona, University of Verona, Dept. of Urology, Verona, Italy, 2. University of Insubria, Dept. of Obstetrics and Gynecology, Varese, Italy, 3. Ospedale di Careggi, University of Florence, Department of Urologic Robotic Surgery and Renal Transplantation, Florence, Italy, 4. ASST Monza, San Gerardo Hospital, Gynecological Surgery Dept., Monza, Italy, 5. Università di Foggia, Department of Urology and Renal Transplantation, Foggia, Italy, 6. AUSL Romagna ambito territoriale Ravenna, Ospedale Civile Lugo Dept. Urology, Ravenna, Italy, 7. Ospedale Magalini, Department of Obstetrics and Gynecology, Villafranca, Italy, 8. Department of Gynaecology, Endocrinology and Gynaecologic Oncology, Szczecin, Poland, 9. Beata Vergine Hospital, Dept. of Obstetrics and Gynecology, Mendrisio, Switzerland
Presenter
M

Matteo Balzarro

Links

Abstract

Hypothesis / aims of study
In urogynecology there are no data on the preferred sutures used to close colpotomy in the anterior compartment. Moreover, we don’t know if the different timing of resorption of the sutures may have a rule in the incidence of complications. 
First aim of this study was to assess if the type of suture used to close anterior colpotomy may impact on wound healing in women with native tissues surgeries, and in those with prosthetic material implantation. Second aim was to assess if the stitching technique may be related with better wound healing. Others outcomes were to evaluate how vaginal colpotomy was closed by different surgeons, and to assess surgical in relation to the type of used suture.
Study design, materials and methods
This is a multicenter, prospective study involving nine different urological/gynecological departments and 13 surgeons skilled in urogynecology. Study design. Recruitment: women naïve for urogynecological surgery affected by anterior vaginal wall defect, stress urinary incontinence. Surgical procedures: anterior vaginal wall repair (AVWR) with native tissue (N-AVWR) or polypropylene mesh (M-AVWR), middle urethral sling (MUS). Used sutures: Vycril 2-0, Vycril Rapide 2-0, Monocryl 3-0. Stitching technique: running interlocking, interrupted. Surgeons performed the type of suture, and the kind of stitching technique usually used. Data collected were: the type of suture; the stitching technique; surgical technique data (kind and length of incision, procedure); wound, length and treatment dehiscence; dyspareunia; leucorrhea; vaginal discharge; the duration of vaginal blood spots. Complications were ranked by Clavien-Dindo scale. Follow-up was done in outpatient clinic at the discharge, after 30 days, and 3 months later. Suture failure was considered in case of wound dehiscence and when the tape/mesh extrusion was at the level of the area of suture within 30 days of surgery.
Results
An amount of 1139 patients were enrolled. In all the cases there was a vertical midline vaginal incision, with a length ranging from 1 cm (MUS) to 4 cm (AVWR). AVWR were 790, 89.1% N-AVWR and 10.9% M-AVWR, while polypropylene MUS were 349. Therefore, a total amount of 435 women (38.2%) had synthetic material implantation, and 704 (61.8%) had native tissue repair.
Sutures used (Table 1):
The sutures used to close the anterior colpotomy of N-AVWR were Vicryl 53.97%, Vicryl Rapide 33.6%, and Monocryl 12,3%. In M-AVWR Vicryl was used in 58.1%, Vicryl Rapide in 41.9%. 
MUS procedures were 349, Vicryl was used in 184 (52.7%), Vicryl Rapide in 153 (43.8%), Monocryl in 12 (3.4%). 
Stitching technique (Table 1):
In N-AVWR the stitching technique was running interlocking in 674 patients (83.5%), while interrupted were 30 (16.5%). In M-AVWR, 35 (40.7%) running interlocking and 51 (59.3%) interrupted.
In MUS running interlocking in 49 (14%), while interrupted in 300 (86%). 
Wound dehiscences (Table 2):
Wound dehiscences were 5 in AVWR (2 N-AVWR, 3 M-AVWR), and 5 in MUS. Therefore, 80% (8/10) of dehiscences were in women with implanted prosthetic material (Chi-Square test p 0.0062, with Yates correction p 0.016).
Comparing data:
Analysing the stitching technique in wound dehiscences we found: 3 running interlocking sutures (1 Vycril, 1 Monocryl, 1 Rapide), 7 interrupted sutures (4 Vycril, 1 Monocryl, 2 Rapide). Using Chi-Square with test Yates correction we did not found significative correlation between wound dehiscences and the kind of stitching technique (p 0.058). Analysing the three different materials used for suturing and the rate of wound dehiscence for each material we did not find a statistical difference (p 0.66).
Overall, all wound dehiscences with underlying prosthetic material (80%) were surgically closed and the other conservatively managed. Ranking complication with the Clavien-Dindo scale we had 3 case of Grade III complications, two IIIa and 1 IIIb. At 3 months none of the patient had wound complication.
Outcomes of surgery at 3 months follow-up did not differ comparing the kind of suture used and/or the kind of suturing technique.
Interpretation of results
We collected interesting data on the type of suture and the suture technique used by gynaecologists and urologists in vaginal surgery. For the first time in the literature our study highlights how the presence of prosthetic material is a risk factor for wound dehiscence regardless of the type of suture used to close the wound. Moreover, we have documented how stitching techniques are not related to the incidence of wound dehiscences. Wound dehiscences were conservatively treated only in native tissues surgeries. The kind of suture and stitching technique used did not impact remarkably on the outcomes.
Concluding message
This study showed that outcomes of patients did not relevantly change according to the suture and stitching technique used. However, prosthetic material implantation has a statistically significant risk of dehiscence in the colpotomy site. Thus, our data documented how the surgeons can choose sutures and stitching technique according to their personal preferences.
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Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee Surgical Department Internal Committee Helsinki Yes Informed Consent Yes