Comparison of Mesh-Based and Mesh-Free Laparoscopic Pectopexy in Uterus-Preserving Surgery for Apical Prolapse

Havva Betül Bacak81 enrolled

Overview

This retrospective cohort study compares anatomical and functional outcomes of mesh-based and mesh-free laparoscopic uterus-preserving pectopexy in women with apical pelvic organ prolapse. A total of 81 patients were included between 2021 and 2024 (mesh-based: 41, mesh-free: 40). Key outcomes assessed included operative time, blood loss, hospital stay, anatomical correction (POP-Q), sexual function (PISQ-12), and complications. Both techniques significantly improved prolapse and sexual function. Mesh-based pectopexy offered superior apical and posterior support, while mesh-free pectopexy was associated with longer vaginal length and longer operative time. Complication and recurrence rates were low and similar across groups. The findings suggest that both techniques are effective, and surgical approach should be tailored to patient preference and clinical context.

This retrospective cohort study was conducted to compare the anatomical and functional outcomes of mesh-based and mesh-free laparoscopic uterus-preserving pectopexy in the treatment of apical pelvic organ prolapse (POP). POP is a common condition among women, particularly those over 50 years of age, characterized by the descent of pelvic organs into the vaginal canal. While mesh-based procedures are known to offer robust apical support, they are associated with long-term complications such as mesh erosion, infection, and chronic pelvic pain. In contrast, mesh-free techniques may offer a safer alternative, particularly for patients wishing to avoid synthetic implants. A total of 81 patients who underwent laparoscopic pectopexy between 2021 and 2024 at a tertiary care institution were included. Patients were divided into two groups based on the use of mesh: 41 underwent mesh-based and 40 underwent mesh-free procedures. Preoperative and postoperative assessments were conducted using the POP-Q (Pelvic Organ Prolapse Quantification) system for anatomical staging and the PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire) for evaluating sexual function. Operative time, estimated blood loss, length of hospital stay, postoperative complications, and recurrence rates were also analyzed. Follow-up evaluations were scheduled at 6 weeks, 3 months, and 1 year. The study found that both techniques significantly improved anatomical support and sexual function. Mesh-based pectopexy provided better apical and posterior compartment support, while the mesh-free approach resulted in a longer vaginal length and was preferred by patients seeking to avoid mesh-related complications. Operative time was significantly longer in the mesh-free group. Complication and recurrence rates were low and comparable between groups. This study contributes to the growing body of evidence supporting uterus-preserving surgical options in POP treatment and highlights the importance of individualized surgical planning based on patient needs, preferences, and clinical profiles.

Interventions

Mesh-free laparoscopic uterus-preserving pectopexyPROCEDURE

Laparoscopic pectopexy without synthetic mesh was performed by utilizing native tissue fixation techniques. The uterus was suspended to the iliopectineal ligaments using permanent sutures without mesh implantation. The procedure aimed to provide apical support and avoid mesh-related complications. Postoperative follow-up included assessments of anatomical correction, functional recovery, and patient satisfaction.

Mesh-based laparoscopic uterus-preserving pectopexyPROCEDURE

Laparoscopic pectopexy was performed using a synthetic mesh to provide apical support while preserving the uterus. The mesh was bilaterally fixed to the iliopectineal (Cooper's) ligaments, and the uterus was suspended in a tension-free manner. This technique is designed to restore pelvic anatomy and improve symptoms of prolapse. Patients were followed postoperatively to assess anatomical success, complications, and functional outcomes.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Diagnosis of pelvic organ prolapse (POP) classified as stage 2 or higher according to the POP-Q (Pelvic Organ Prolapse Quantification) system * Desire for uterus preservation and refusal of hysterectomy during surgery * Eligible for surgical intervention and able to undergo general anesthesia * Women aged 18 years and older with pelvic organ prolapse Exclusion Criteria: * History of hysterectomy * Severe comorbidities (e.g., serious cardiovascular diseases, bleeding disorders, or other medical conditions that may interfere with surgical treatment) * Active infections in the pelvic or urogenital region * Advanced malignancies (e.g., cancer) * Psychological or cognitive impairments preventing informed consent or compliance with postoperative follow-up

Outcomes

Primary Outcomes

Anatomical Success According to POP-Q System

Anatomical success is defined as apical pelvic support at stage 0 or I according to the Pelvic Organ Prolapse Quantification (POP-Q) system. Specific points evaluated include C (cervix or vaginal cuff), D (posterior fornix if applicable), Ba, Bp, and TVL (total vaginal length). Success indicates restored apical support without need for additional surgical intervention or evidence of recurrence at 1-year follow-up.

Time frame: 1 year postoperatively

Change in Sexual Function Based on PISQ-12 Score

Sexual function was evaluated using the validated Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Scores range from 0 to 48, with higher scores indicating better sexual function. The primary endpoint was the change in total PISQ-12 score from baseline (preoperative) to 1 year postoperative. Improvements were compared between the mesh-based and mesh-free pectopexy groups to assess functional recovery related to sexual health.

Time frame: Baseline to 1 year postoperatively