A Comparative Evaluation of Double Versus Loop Suture Techniques in Sacrospinous Ligament Fixation Over Two Years.

Abstract

Introduction and hypothesis: Sacrospinous ligament fixation (SSF) is a widely accepted native tissue technique for apical pelvic organ prolapse (POP), especially following the decline in mesh-based procedures. However, the optimal suture technique remains under debate.

Objectives: To compare the clinical outcomes of double versus loop suture techniques in SSF, with a focus on operative efficiency, complications, recurrence, and reoperation rates over a 24-month follow-up.

Patients and methods: This retrospective cohort study included 195 patients with stage 3 or 4 POP who underwent SSF with nonabsorbable polypropylene suture between January 2020 and January 2023 in a tertiary-care academic hospital specializing in urogynecologic surgery. Group 1 (n = 115) underwent classical double suture SSF, while group 2 (n = 80) received the loop suture technique. Demographic characteristics, operative times, perioperative complications, recurrence, and reoperation rates were recorded and compared between the groups.

Main outcome measures: Primary outcomes were total operative time. Secondary outcomes included postoperative complications such as gluteal pain, recurrence rate, and reoperation rate.

Results: Both groups were similar in age, BMI, and baseline POP stage. The loop suture group had significantly shorter total operative time (154.04 ± 41.83 vs. 112.85 ± 37.34 min, p < 0.001) and SSF-specific surgical time (59.09 ± 22.97 vs. 37.34 ± 10.91 min, p < 0.001). Although recurrence rates were similar (24.3% in the double suture group vs. 18.7% in the loop suture group, p = 0.452), reoperation was significantly less frequent in the loop group (5% vs. 14.7%, p = 0.035). Gluteal pain occurred more often in the double suture group, although these differences were not statistically significant.

Conclusion: The loop suture technique appears to be a safe and efficient alternative to the classical double suture method for SSF, offering reduced operative time and lower reoperation rates without compromising effectiveness.