In this study, we analyze the perioperative (related to the surgery), short tearm (1 year), and long term (10 years) outcome of a single institution cohort undergoing minimally invasive sacrocolpopexy.

All patients undergoing minimally invasive (laparoscopic) mesh sacrocolpopexy (LMS) between 2003 and 2016 were included and contacted by phone in June 2022 for subjective long-term follow-up. 
Pre-operatively, all patients underwent a thorough clinical examination. Tension free vaginal tape (TVTO) was simultaneously inserted only in patients complaining of urinary incontinence (SUI) objectified clinically (full bladder cough test after prolapse reduction), or on urodynamic assessment. 
The same standardized surgical technique was performed alternatively by two different surgeons experienced in urogynecological surgery: an anterior-posterior double arm laparoscopic sacrocolpopexy/hysteropexy using a polypropylene monofilament mesh. 
The following data was collected: 
-	Demographic data and risk factors for prolapse: age, number of normal deliveries, body mass index (BMI) in Kg/m2
-	Operative data: operative time (minutes), length of hospital stay (days), conversion rate, simultaneously performed procedures (adhesiolysis, hysterectomy and TVTO) and peri-operative incidents (urinary/digestive tract or blood vessel injuries).
SHORT TERM OUTCOMES, 
Patients were followed up during the first year systematically at 5 weeks and 6 months, and at any other time if there was a specific complain. Early postoperative complications (at one year) were recorded and combined as a composite outcome: voiding difficulties, delayed mobility, wound complications, febrile morbidity, postoperative ileus, thromboembolic phenomena, mesh erosion, constipation and dyspareunia. 
LONG TERM OUTCOMES,
All patients were contacted by phone in June 2022 for a subjective long term follow-up assessment. An independent medical doctor researcher with sufficient urogynecology knowledge called systematically all patients. The same set of questions was asked for all patients and a discussion was performed if deemed necessary to more clarify the symptoms or complains.  
They were asked about the onset of new symptoms preoperatively absent, or recurring post-operatively. The new onset of bulge symptoms at any time follow up was considered a subjective recurrence. The onset of other symptoms: SUI, urge urinary incontinence (UUI), constipation, dyspareunia (if sexually active), were compared between patients considered to have a recurrence and those who did not.
Global satisfaction from the surgery was assessed with a rate going from 0 (not satisfied at all) to 100% (fully satisfied). 
Statistical analysis,
-	All parameters were compared between patients who presented complications and those who did not, using Mann-Whitney test for quantitative non-parametric variables and khi-2 test for qualitative variables. 
-	At long term follow up, patients were considered to have a subjective recurrence if complaining of new onset of bulge symptoms. Several parameters (SUI, UUI, constipation, sexual activity, dyspareunia) were compared between this recurrent group and those who did not complain of a subjective recurrence.

Demographic and operative data is reported in Table 1. Most patients (72%) presented grade 3 POP, 5% grade 2 and 23% grade 4. 
SHORT TERM OUTCOMES (95 patients), 
Grade of prolapse (3±0.4 vs 3±0.5, p<0.01) and hospital stay (3±1.1 vs 3.1±1.7; p<0.01) were significantly higher in patients with complications. BMI (26±4 vs 26±3kg/m2; p=0.9), age at time of surgery (60±6 vs 60±12years; p=0.6) and operative time (156±40 vs 160±30minutes; p=0.9) did not differ. No difference was found between the rate of complications and the insertion of TVTO (p=0.8), adhesiolysis (p=0.3) and the use of only one mesh (p=0.6).
LONG TERM OUTCOMES (48 patients),
Mean time of long follow up was 12±3years. Mean age at time of follow up was 72±12years. Most frequent symptoms, reported at long follow up were: UUI (31%), followed by constipation (21%), then SUI (19%). Amongst sexually active subjects, only 4% complained of dyspareunia at long term follow-up. Surgery satisfaction was of 79±24%. 19% of patients complained of bulge symptoms and were considered to have a subjective recurrence. Recurrent patients were significantly less satisfied than those who did not have a recurrence (61±25 vs 85±17%, p<0.01). Other parameters did not differ: BMI (26±2 vs 26±4 kg/m2; p=0.5), age at time of surgery (56±14 vs 59±10years; p=0.6), operative time (168±28 vs 154±33minutes; p=0.2), length of hospital stay (3.2±0.8 vs 2.8±0.8days; p=0.1), actual age (67±12 vs 70±10years; p=0.6) and FU length (11±2 vs 10±3years; p=0.4).
Patients with subjective recurrence were more likely to present with de novo SUI (p=0.03). It was not the case for UUI (p=0.4), constipation (p=0.3), sexual activity (p=0.8) and dyspareunia (p=0.4).
Symptomatic mesh erosion was diagnosed in three patients at 5, 6 and 10 years postoperatively. All erosions were located at the level of the vagina and cystoscopy did not detect vesical erosion.

In this study, we report the first long term follow-up for laparoscopic mesh sacrocolpopexy. 
SHORT TERM OUTCOMES, 
The two major obstacles to laparoscopic surgery, particularly sacrocolpopexy, were increased weight and age, as these populations were thought to complicate more easily [1]. Our subjects had a mean BMI of 26 and a mean age of 60 at time of surgery. Increased age and BMI did not seem to affect postoperative complications, symptoms, or outcomes. 
Operative incidents were rare in this series, however, first year complications were reported in 11% mostly related to de novo SUI requiring surgical correction. This was associated with higher prolapse grade, while BMI and age were not.
LONG TERM OUTCOMES,
Mesh erosions were diagnosed at long term follow up. It is an interesting finding because all were symptomatically diagnosed after 5 years while previous studies report earlier erosions (latest at the 5th postoperative year)[2]. In our cohort all erosions were located in the vagina and successfully repaired with local excision and suturing by a vaginal approach. This is a relatively low rate as the ACOG states that sacrocolpopexy with mesh is associated with 10% of long term (7 years) mesh related complications (erosions, osteitis) most of which require reoperation[3].
At long term follow up, the most frequently reported de novo symptom was UUI followed by SUI. This new onset of urge urinary incontinence could be related to local inflammatory factors related to late mesh retraction or to other factors related to women’s aging and comorbidities.  
Dyspareunia was reported in only 2 patients of the sexually active subset and is probably related to local dryness following menopause and increased age. Abdominal mesh surgeries are known to cause less dyspareunia than vaginal approaches and this remains true at long follow-up.
Nineteen percent of responders complained a subjective recurrence with bulge symptoms. None of the patient required or demanded a redo-surgery since this recurrence was always less bothersome than pre-operative prolapse. The only symptom associated with the presence of a recurrence was SUI.

Satisfaction rate remains high after 10 years with a low recurrence rate. The most frequently reported urinary symptom of new onset was UUI, while SUI is associated with recurrence of bulge symptoms. Mesh erosion can happen as late as 10 years post-operatively.
Laparoscopic sacrocolpopexy remains one of the best minimally invasive techniques for surgical treatment of urogenital prolapse. It can be offered to young symptomatic patients since the amelioration persists on long follow-up.

A. S. Boudy, T. Thubert, M. Vinchant, J. F. Hermieu, V. Villefranque, and X. Deffieux, “Outcomes of laparoscopic sacropexy in women over 70: A comparative study,” Eur. J. Obstet. Gynecol. Reprod. Biol., vol. 207, pp. 178–183, Dec. 2016, doi: 10.1016/j.ejogrb.2016.11.008
G. Baines, N. Price, H. Jefferis, R. Cartwright, and S. R. Jackson, “Mesh-related complications of laparoscopic sacrocolpopexy,” Int. Urogynecology J., vol. 30, no. 9, pp. 1475–1481, Sep. 2019, doi: 10.1007/s00192-019-03952-7.
I. Nygaard et al., “Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse,” JAMA, vol. 309, no. 19, pp. 2016–2024, May 2013, doi: 10.1001/jama.2013.4919.