title: Sacral mesh pullout strength based on suture location for sacrocolpopexy.
abstract: BACKGROUND
  We sought to compare the pullout strengths of the sacral end of the sacrocolpopexy mesh when attached using one suture at the first versus second sacral vertebral level (S1 vs. S2) in female cadaveric pelvises.
  
  
  METHODS
  The sacral vertebrae were isolated in 9 unembalmed female cadavers, and segments of polypropylene mesh were attached to the sacrum using stitches at either the S1 or S2 level. The free end of the mesh was pulled at a constant rate. Maximum tension prior to system failure was recorded for each specimen. Suture pullout strengths between the two groups were compared using the two-sample Wilcoxon rank-sum test.
  
  
  RESULTS
  In all but one specimen, failure of the system occurred at the point of suture attachment to the anterior longitudinal ligament. Among the nine specimens, median pullout strengths were 7.49 lb (interquartile range 7.95) at S1 and 3.15 lb (interquartile range 2.975) at S2 (p = 0.028).
  
  
  CONCLUSIONS
  The pullout strength of sutures used to attach the sacrocolpopexy mesh to the sacrum is significantly higher at the S1 level than at the S2 level.
authors: Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, VA 23708-2197, USA. stuart.shippey@med.navy.mil
authors: Stuart
authors: S
authors: Shippey
authors: Edward
authors: E
authors: Sutter
authors: Stephen M
authors: SM
authors: Belkoff
authors: Robert
authors: R
authors: Gutman
authors: Chi Chiung Grace
authors: CC
authors: Chen
mesh_terms: D002102:Cadaver; D005260:Female; D006801:Humans; D012447:Sacrum / Q000601:surgery*; D013526:Surgical Mesh; D013536:Suture Techniques; D013718:Tensile Strength; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*