Best Suture Material for Infundibulopelvic Ligament Repair
For infundibulopelvic ligament repair, interrupted non-absorbable 2-0 or 1-0 monofilament sutures are recommended as they provide optimal strength and security while minimizing tissue reaction and bacterial seeding.
Optimal Suture Material Characteristics
- Non-absorbable sutures are preferred for infundibulopelvic ligament repair due to the need for long-term strength in this critical vascular structure 1
- Monofilament sutures are recommended over multifilament (braided) sutures as they cause less bacterial seeding and may reduce infection risk in this critical area 1, 2
- Suture size of 2-0 or 1-0 provides appropriate tensile strength for securing the infundibulopelvic ligament 1
- Interrupted suture technique is preferred over continuous suturing for infundibulopelvic ligaments to provide multiple points of security 1
Specific Suture Material Options
- Polypropylene (Prolene) is an excellent choice as a non-absorbable monofilament suture with high tensile strength and minimal tissue reactivity 3
- Polybutester suture represents a newer advance in non-absorbable sutures with excellent handling characteristics and elasticity that may be beneficial for vascular pedicles 3
- If absorbable sutures must be used, slowly absorbable monofilament options like polydioxanone (PDS) are preferable to rapidly absorbing materials 1
Technical Considerations
- A two-layer closure technique using interrupted non-absorbable mattress sutures provides optimal security for the infundibulopelvic ligament 1
- The "clinch knot" technique has been found especially useful for securing pedicles in relatively inaccessible places such as the infundibulopelvic ligament 4
- When tying sutures in the infundibulopelvic ligament, ensure adequate tension without strangulating the tissue, as this can lead to necrosis 1
- For laparoscopic procedures, specialized techniques such as the ovarian suspension loop can help stabilize the area during repair without damaging the infundibulopelvic ligament 5
Potential Complications and Considerations
- Excessive tension on sutures can lead to tissue necrosis and suture failure 1
- Inadequate suture strength may result in hemorrhage from the infundibulopelvic vessels 6
- Permanent sutures may be associated with increased immediate postoperative pain compared to absorbable options, though this finding was from sacrospinous ligament studies rather than infundibulopelvic ligament specifically 7
- Monofilament sutures have less bacterial seeding but may be more difficult to handle and tie securely compared to braided sutures 1, 3
Summary of Evidence-Based Recommendations
- Use interrupted non-absorbable 2-0 or 1-0 monofilament sutures for infundibulopelvic ligament repair 1
- Apply a two-layer closure technique with mattress sutures for optimal security 1
- Consider specialized knot techniques like the clinch knot for better security in this anatomically challenging location 4
- Ensure adequate tension without strangulating the tissue to prevent necrosis while maintaining hemostasis 1