Outcomes of combined laparoscopic repair for advanced pelvic organ

Abstract

<h4>Background</h4>Laparoscopic lateral suspension (LLS) is a novel technique for repairing anterior and apical pelvic organ prolapse (POP). However, the efficacy is limited for advanced apical defects, particularly when combined with posterior compartment prolapse. This preliminary study evaluated the short-term outcomes of mesh-based LLS combined with uterosacral ligament suspension (USLS) for treating advanced apical prolapse with involvement of both the anterior and posterior compartments.<h4>Methods</h4>Between January 2022 and June 2024, 28 women with apical POP ≥ stage III underwent mesh-based LLS with USLS. Titanized polypropylene mesh was placed on the vesicovaginal fascia, and the posterior compartment defects were addressed with USLS. All patients preserved their uterus. Clinical outcomes were assessed using the gynecological examination and the pelvic organ prolapse quantification (POP-Q) system. Objective anatomic success was defined as POP-Q stage <II at all points at 12-month follow-up. Subjective outcomes were measured with the Pelvic Floor Distress Inventory Questionnaire.<h4>Results</h4>The mean age of participants was 57.71 ± 10.36 years, with a mean BMI of 25.48 ± 2.87 kg/m². Concomitant procedures included distal posterior vaginal wall repair (<i>n</i> = 16), partial cervical resection (<i>n</i> = 5), hysteroscopy (<i>n</i> = 9), and other procedures. No serious perioperative complications occurred in the patients. While anatomical restoration was high in this small cohort (100%), these results are preliminary. Subgroup analysis showed no significant difference in point Bp restoration between patients with and without distal vaginal repair (<i>p</i> > 0.05). No serious complications or mesh exposure occurred.<h4>Conclusion</h4>Combining LLS with USLS is a safe and potentially effective treatment for advanced, multi-compartment apical prolapse in this preliminary cohort. While short-term outcomes are encouraging, the lack of a control group and the potential confounding effect of distal vaginal repair necessitate larger studies to confirm long-term durability.