Long-term comparison of non-mesh anchoring vs mini mesh for apical suspension.

Abstract

<h4>Importance</h4>Apical pelvic organ prolapse (aPOP) significantly impacts quality of life, and its optimal surgical management remains debated. Minimally invasive vaginal approaches offer potential advantages over abdominal methods, particularly in terms of recovery, morbidity, and long-term function. However, comparative long-term data between non-mesh and mini-mesh solutions are limited.<h4>Objectives</h4>To compare long-term outcomes and patient satisfaction between two minimally invasive surgical techniques for aPOP repair: the non-mesh EnPlace® anchoring system and the Seratom MN2® mini-mesh implant.<h4>Study design</h4>A retrospective cohort study of 200 patients undergoing sacrospinous ligament fixation (SSLF) via either the EnPlace® (n = 100) or Seratom MN2® (n = 100) systems at a single center (2013-2022). Groups were matched by follow-up duration. Primary outcomes included anatomical success and patient satisfaction; secondary outcomes included operative details, complications, and postoperative recovery. Statistical analysis used Mann-Whitney U and chi-square tests.<h4>Results</h4>Both groups showed high long-term anatomical success (EnPlace®: 96.74 %; Seratom MN2®: 98.89 %). Patient satisfaction was significantly higher in the EnPlace® group at long-term follow-up (89.33 % vs. 74.67 %, p = 0.034). EnPlace® was associated with shorter operative time (23.4 vs. 29.9 min, p < 0.001), less blood loss (23.6 vs. 31.8 cL, p < 0.001), and reduced hospital stay (1.02 vs. 2.00 days, p < 0.001). Pain duration and severity were also significantly lower with EnPlace®.<h4>Conclusion</h4>Both systems demonstrated high efficacy and safety in apical prolapse repair. However, the EnPlace® system provided advantages in patient satisfaction, surgical efficiency, and postoperative recovery.<h4>Why this matters</h4>Sacrospinous ligament fixation (SSLF) is a common vaginal surgical technique for the treatment of apical pelvic organ prolapse (aPOP), including both uterine and vaginal vault descent. It offers a minimally invasive alternative to abdominal approaches, with reduced morbidity and faster recovery. Over time, various SSLF-based techniques have emerged, differing in the use of mesh, dissection depth, and anchoring mechanisms, aiming to improve safety and durability while preserving patient quality of life. This study presents a long-term comparison between two contemporary SSLF approaches. The EnPlace® system uses a meshless, anchor-based method requiring minimal dissection, while the Seratom MN2® system utilizes a small, partially absorbable mini-mesh to reinforce the apical and anterior/posterior compartments. Both were designed to minimize surgical trauma and maximize anatomical support. Following 200 women for up to ten years, our findings demonstrate that both techniques are effective and safe options for aPOP repair, each achieving high rates of long-term anatomical success. However, statistically significant differences were observed favoring EnPlace® in patient satisfaction, operative time, and postoperative recovery. These results contribute valuable evidence to support tailored decision-making in apical prolapse surgery and emphasize the clinical relevance of technique selection within SSLF.