title: Titanium Surgical Tacks: Are They Safe? Do They Work?
abstract: Minimally invasive approaches to sacrocolpopexy have transformed it into a primary procedure for treatment of pelvic organ prolapse. Certain modifications are commonly used to facilitate the laparoscopic approach, but have not yet been widely studied. In this study, we investigated the efficacy and safety of titanium surgical tacks for the attachment of mesh to the anterior longitudinal ligament in laparoscopic sacrocolpopexy.
  
  
  
  This retrospective cohort study involved all patients within 1 health care system who underwent laparoscopic sacrocolpopexy between January 2009 and December 2012. Each medical record was reviewed and abstracted.
  
  
  
  Of the 231 patients included in our study, 190 (82%) had titanium surgical tacks, and 41 (18%) had suture for mesh attachment to the anterior longitudinal ligament. The demographics of the 2 subgroups as well as concomitantly performed procedures were comparable. There was no significant difference found between the 2 cohorts in regards to operative time, estimated blood loss, complication rates, rate of recurrent pelvic organ prolapse symptoms or the rate of reoperation for pelvic organ prolapse.
  
  
  
  Surgical tacks are a safe alternative to suture for the attachment of mesh to the anterior longitudinal ligament in laparoscopic sacrocolpopexy. Although we saw no advantage to using tacks over suture, tacking the mesh to the anterior longitudinal ligament may make the laparoscopic approach more accessible to a wider range of gynecologic surgeons. Further studies about the long-term impact of surgical tacks on bone and disk disease are needed.
authors.affiliation: From the *Department of Obstetrics and Gynecology, †Division of Research, and ‡Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Abigail
authors.initials: A
authors.lastname: Shatkin-Margolis
authors.forename: Maqdooda
authors.initials: M
authors.lastname: Merchant
authors.forename: Rebecca U
authors.initials: RU
authors.lastname: Margulies
authors.forename: Olga
authors.initials: O
authors.lastname: Ramm
mesh_terms: D016022:Case-Control Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013526:Surgical Mesh; D013537:Sutures; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D014025:Titanium