Barbed Suture Strength in Sacrocolpopexy: Does Pattern Matter?

Importance: Although barbed suture in sacrocolpopexy is becoming increasingly common, an accepted vaginal attachment pattern for barbed suture has not been established.

Objective: This study aimed to compare the structural properties of 3 different barbed suture attachment patterns used to fixate mesh to the vagina during sacrocolpopexy.

Study design: Segments of type 1 polypropylene mesh (Restorelle; Coloplast, Humlebaek, Denmark) measuring 6 × 3 cm were affixed to rectus abdominis fascia from 5 fresh-frozen female cadavers. Barbed 6-inch 2-0 polydioxanone (Stratafix; Ethicon, Raritan, NJ) with 3 different attachment patterns and nonbarbed 2-0 polydioxanone were used for fixation. Barbed suture attachment patterns included circular, horizontal, and vertical patterns. Mechanical testing was carried out using a uniaxial tensile test to failure.

Results: Tensile testing resulted in similar mechanical properties across all suture attachment pattern groups. Analyses found no significant effect of suture attachment pattern stiffness or the extension at failure. One-way ANOVAs revealed a global effect of suture attachment pattern on the load at failure (P = 0.0188) and energy at failure (P = 0.0435), but this significance was eliminated after controlling for multiple comparisons. A significant (P = 0.0459) increase in ultimate load was found when comparing the horizontal attachment pattern to the vertical attachment pattern.

Conclusions: No difference was observed when comparing suture attachment patterns (circular, horizontal, and vertical). However, a statistically significant difference in ultimate load favored the horizontal attachment over the vertical attachment. Furthermore, there was no difference observed when comparing nonbarbed interrupted suture attachment to the 3 barbed suture attachment patterns.