Laparoscopic ventral rectopexy plus sacral colpopexy: continuous locked suture for mesh fixation. A randomized clinical trial

• Published in: Archives of gynecology and obstetrics Vol. 306; no. 5; pp. 1573 - 1579
• Main Authors: Morciano, Andrea, Caliandro, Dario, Campagna, Giuseppe, Panico, Giovanni, Giaquinto, Alessia, Fachechi, Giorgio, Zullo, Marzio Angelo, Tinelli, Andrea, Ercoli, Alfredo, Scambia, Giovanni, Cervigni, Mauro, Marzo, Giuseppe
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2022; Springer Nature B.V
• Subjects: Clinical trials; Endocrinology; General Gynecology; Gynecology; Human Genetics; Laparoscopy; Medicine; Medicine & Public Health; NCT; NCT05254860; Obstetrics/Perinatology/Midwifery; Surgical outcomes; Sutures; Vagina; Rectal prolapse; Sacral colpopexy; Laparoscopy; Ventral rectopexy; Mesh fixation
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-022-06682-2

Purpose Laparoscopic ventral rectopexy (LVR) plus sacral colpopexy (LSC) is a high-complexity surgical procedure. The aim of the present study was to evaluate a new approach to rectal-mesh fixation during LVR with continuous locked suture. Methods This is a prospective randomized double-blinded clinical trial enrolling 80 patients with severe POP and obstructed defecation syndrome (ODS) from November 2016 to January 2021. Patients underwent a “two-meshes” LSC plus LVR and were randomized, regarding rectal mesh fixation, in Group A (extracorporeal interrupted 0 delayed absorbable sutures) and Group B (“U-shaped” running locked 0 delayed absorbable suture). Our primary endpoints were the operative times (OT); the secondary endpoints were the incidence of anatomical failures, vaginal mesh erosions and surgical complications. Results A total of 75 patients completed the study. Baseline characteristics were similar between the groups. Overall OT (156 vs 138 min; p  < 0.05; treatment reduction of 11.5%) and LVR mesh fixation time (29 vs 16 min; p  < 0.05; treatment reduction of 44%), resulted in significantly lower in Group B. No differences were found in terms of anatomic failure, vaginal mesh erosion or intra- or post-operative complications. PGI-I, FSDS and Wexner questionnaires resulted significantly improved after surgery, without statistical differences between the studied surgical procedures. Conclusion Laparoscopic continuous locked 0 absorbable suture for LVR mesh fixation guaranteed a faster and effective alternative to multiple interrupted sutures. The significant OT reduction linked to this technique should be considered even more helpful when performing a highly complex surgery such as LVR. Clinical trial registration NCT05254860 (13/02/2017).