multifilament suture are easier to handle. In particular, multifilament suture has less memory than monofilament suture and therefore is more pliable requiring less knots to secure it. Monofilament suture, conversely, passes through tissue easier than multifilament and typically with less of an inflammatory reaction.
TABLE 51.1 Synthetic Sutures Commonly Used in Female Pelvic Medicine and Reconstructive Surgery
TABLE 51.2 Suture Material and Degradation Time
The necessity of this practice has been questioned by a retrospective cohort study of robotic sacrocolpopexy using absorbable suture (polyglactin 910) for sacral attachment. At a median follow-up of 33 months 10 patients (7.6%) had prolapse recurrence, however, only 2 had apical failure (only 1 of which appeared to have mesh detached from the sacrum). This finding suggests that nonabsorbable suture may be utilized for sacral attachment.14
tissue that provides strength to the site of repair.32 They have a lower risk of infection, mesh exposure, or erosion.33,34 The resultant scar tissue, however, has less mechanical stability when compared to scar tissue containing nonabsorbable mesh.33,35 This theoretically can lead to an increased risk of recurrent pelvic organ prolapse.
TABLE 51.3 Comparison of Reconstructive Materials
with the surrounding tissues.38,39 Moreover, the large pore size allows for immune cells (>20 micrometers) to phagocytize bacteria throughout the mesh field. Type 1 mesh is currently the preferred choice for pelvic reconstructive surgery as it is associated with fewer complications compared to type 2 and 3 meshes.40 Specifically, as discussed in detail in the following text, lightweight type 1 materials (pore sizes greater than 1 mm in diameter) are less stiff and more suitable for use in the vagina given vaginal requirements to accommodate change in volume with stooling and intimacy.41
TABLE 51.4 Amid Classification of Synthetic Mesh