Gluteal-cutaneous Sinus Formation Following Sacrospinous Hysteropexy: A report of two cases

Objective: This case report highlights a rare complications of gluteal-sacrospinous sinus formation and associated osteomyelitis years post-sacrospinous hysteropexy using Ethibond (Ethicon Inc., USA) sutures in both cases.

Case report:

Case 1: A 72-year-old postmenopausal woman presented six years post-sacrospinous hysteropexy with a discharging sinus in the right buttock. Imaging revealed a sinus tract extending from the posterior cervix to the gluteal region. Surgical exploration revealed the presence of Ethibond Excel sutures at the sacrospinous ligament, leading to their removal. Excision and curettage of the sinus resolved the condition, with complete healing after two month

Case 2: A 63-year-old woman developed chronic sinus and osteomyelitis four years after undergoing sacrospinous hysteropexy. Imaging revealed a sinus tract extending from the sacrospinous ligament to the ischio-anal fossa. She experienced significant hip pain and reduced mobility. Surgical removal of the Ethibond sutures alleviated the sinus discharge, but the tract persisted. Over the following year, the sinus healed completely, though her mobility remained restricted. A multidisciplinary approach involving orthopaedics and physiotherapy led to improved mobility with only minor residual limitations.

Discussion:

These cases highlight rare but serious sacrospinous hysteropexy complications, particularly when using non-absorbable braided sutures like Ethibond (Ethicon Inc., USA). Similar cases in the literature suggest that these sutures may help cause chronic inflammation, suture erosion, and the formation of sinuses. Monofilament sutures may be a safer alternative, as they are less likely to act as a nidus for infection.

Early recognition through imaging and prompt surgical management are crucial to achieving favourable outcomes. Long-term follow-up and patient education regarding complications are equally significant.

These cases highlight the need for additional research into the suture materials needed to get the best outcomes.