Pelvic organ prolapse (POP) is a prevalent condition affecting many women, particularly in the postmenopausal age group. Laparoscopic sacropexy is considered the gold standard for its treatment, but laparoscopic pectopexy has emerged as a less invasive alternative. However, comprehensive comparative studies between the two procedures are lacking.

We prospectively enrolled 80 women with POP-Q stage II or higher and performed either laparoscopic pectopexy(n=39) or sacropexy(n=41). The two groups assessed and compared demographic characteristics, intraoperative and postoperative parameters, objective and subjective outcomes, and complications.

Both procedures demonstrated effectiveness in treating POP, with differences observed in certain parameters. Patients undergoing pectopexy were older(p<0.01) and had higher parity than those in the sacropexy group, reflecting surgeon or patient preference for a less invasive procedure. The postoperative pain score at 6 hours  or 24 hours  were similar in both groups. The hospital stay were 3.95±1.82 days in the pectopexy and 4.17±2.76 days in the sacropexy group with no significant difference. The complications of pectopexy and sacropexy group revealed some procedure-specific complications. Pectopexy was associated with shorter operation time(146.62±36.62 minute, p=0.01) and less blood loss(27.69±73.18 ml, p<0.05), while sacropexy showed slightly better Aa, Ba, and Ap points at 12 months (p<0.05). The subjective outcomes were responded according to the questionaries (Table 4). In the preoperative and postoperative 12-month comparison, both the pectopexy and sacropexy patients had much improvement.

The comparison between laparoscopic pectopexy and sacropexy for treating pelvic organ prolapse (POP) is essential for guiding surgical decisions. Our study sheds light on their clinical outcomes, revealing notable differences that can influence patient care.
Patients undergoing pectopexy were typically older and had higher parity, indicating a possible preference for a less invasive procedure in this demographic. Pectopexy showed advantages such as shorter operation time and less blood loss, aligning with previous findings. Although both procedures had similar short-term recovery periods, sacropexy carried a higher risk of severe complications like postoperative ileus, discitis, and vascular injury. Objective outcomes measured by POP-Q points demonstrated significant improvement in both groups, but sacropexy showed better results in the anterior and posterior compartments at the 12-month follow-up. This may suggest that the fixation sites of pectopexy may not achieve the same height as sacropexy, possibly requiring additional procedures to prevent long-term recurrence. Subjective outcomes were similar between the two procedures, indicating comparable patient satisfaction. Our study's strengths lie in providing comprehensive objective outcomes and utilizing sufficient sample sizes with high patient compliance. However, limitations include the lack of randomization and long-term postoperative follow-up.

Our study supports the existing body of evidence while providing new data on the objective outcomes of these procedures. Our findings suggest that pectopexy and sacropexy are viable options for POP surgery, but pectopexy may experience earlier descent in the anterior compartment than sacropexy. The choice of procedure should be tailored to the individual patient's characteristics, considering the patient's age, possible complications, and specific prolapse compartment predominance. We recommend that future research explore long-term subjective and objective outcomes of the pectopexy.

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Yang Y, Li Z, Si K, et al (2023) Effectiveness of Laparoscopic Pectopexy for Pelvic Organ Prolapse Compared with Laparoscopic Sacrocolpopexy. J Minim Invasive Gynecol 30:833-840.e2. https://doi.org/10.1016/j.jmig.2023.06.011

Continence 12S (2024) 101497
DOI: 10.1016/j.cont.2024.101497