The treatment of  pelvic organ prolapse has switched in the past decades from traditional native tissue repair to the synthetic mesh suspension methods - vaginal or abdominal. A higher proportion of their success and durability is dependend on a good quality anchoring system that can withstand the high pressures that affect the pelvic floor during coughing and a Valsalva.
Nowadays, mesh kits usually use the sacrospinous ligament for the fixation of the mesh in cases of anterior, posterior and also apical defects. The manufacturers use different barbed plastic anchors  (in one or two levels) or devices dragging the mesh arms through these ligaments. 
The focus of this presentation is the completion of an earlier experiment which  compared the necessary pull-out resistance of available anchoring means in the treatment of apical prolapse in vaginal surgery.

The fixation resistance of different mesh kits, or stitches,  is at the forefront of our long-term research and practical interests. The fundamental reasoning is an effort to estimate the difference in immediate adherence of materials used between the methods available. 
As a substitute fixation structure for anchoring the mesh we use a standardized part of porcine sacrotuberous ligament which is close to the volume and structure of the female sacrospinous ligament.
For the comnparison this time we have added a selection of kits that we have used so far (Elevate-AMS, Nuvia-Bard, Calistar-Promedon) and the newest development in the field – EndoFast Reliant (Allium Medical) with special Spider Fasteners.
The measurement of pull-out forces under discussion was performed on the MTS Mini Bionix servohydraulic system using the software FlexTest GT (PM 00/11). This instrument subjected the materials under investigation to increasing tensile force with the aim of determining the strenght requiered to break the fixation.

Results documenting the maximum force needed for extraction of the implants tested are shown in Table 1.
It summarises the pull out strength for the kits nowadays in use, and also for sacrospinous  ligament stitch even if it is no longer used frequently as prior to introduction of prolene meshes. Even if the values of individual products differ, we must remember that this is the immediate adherence of anchoring tools and that the result of anchoring after a longer period will not be unfavourable for kits with low initial values.
Graph 1 shows a comparison of the pattern of extraction force for all the kits.
Of the kits currently used, the products with anchors showed the highest adherence to the target tissue. Those with mesh arms dragged through the ligaments achieved inferior values.

We have determined a maximum force needed to pull the different implants out of the substitute porcine ligament. For the latest one under discussion- ENDOFAST IBI the maximum force requiered for extracting the implant  was 15 N, i.e. concerning primary fixation the spider fastener showed only an average adherence, still capable of supporting pelvic floor during cough.

We have determined a maximum force needed for pull the different implants out of the substitute porcine ligament. For the new kit under discussion- ENDOFAST IBI the maximum force requiered for extracting the implant power was 15 N, i.e. concerning primary fixation the spider fastener showed the average adherence capable of supporting pelvic floor during cough.

Int Braz J Urol. 2012; 38(2):258-65
Am J Obstet Gynecol.2012; 207(4):301.e1-7