Suture Type Affects Outcomes in Vaginal Prolapse Surgery

The use of size 1 multifilament sutures, when compared with 2/0 monofilament sutures, in pelvic organ prolapse surgery with vaginal closure was associated with a significantly higher number of short-term complications, according to a study conducted by researchers from the department of obstetrics and gynecology at Medway National Health Service Foundation Trust in Gillingham, United Kingdom.¹

To better understand whether different suture materials are associated with different rates of early postoperative morbidity, researchers compared 2 cohorts of women undergoing pelvic organ prolapse surgery, which can be associated with early postoperative morbidity resulting in significant service utilization. In one cohort, 100 women underwent pelvic organ prolapse surgery with vaginal closure using size 1 polyglycolic acid (Vicryl) multifilament sutures, and a matched cohort included 100 women undergoing the same surgery in which 2/0 poliglecaprone 25 (Monocryl) monofilament sutures were used.

Significantly higher rates of offensive vaginal discharge (P<.001), vaginal bleeding (P<.001), and vaginal pain (P=.004) occurred in the multifilament suture group compared with the monofilament suture group.¹ Women in the multifilament suture group were also more likely to require postoperative medical care (P=.007). However, there were no differences between the suture groups in rates of urinary tract infections or postoperative readmissions.

Although there are no obvious advantages of using multifilament sutures over monofilament sutures, previous studies involving a variety of tissues have found that monofilament sutures may have more beneficial wound healing properties than multifilament sutures. For example, multifilament sutures have been found to cause more microtrauma to the surrounding tissues,² cause a more severe inflammatory response,³ are associated with larger knot volumes than monofilament sutures of equal size,⁴ and exhibit enhanced capillarity that increases the risk of the transport and spread of microorganisms.⁵ In addition, multifilament sutures have been associated with an increased risk of hypertrophic scar formation when compared with monofilament sutures, although this study involved breast tissue and the results may not be comparable to vaginal tissue.⁶ One benefit of multifilament sutures over comparably strong monofilament sutures is that the currently available multifilament sutures are generally perceived to be easier to handle and more flexible.⁷

Pertinent Point:
- The use of size 1 multifilament sutures was associated with significantly higher postoperative morbidity when compared with 2/0 monofilament sutures.