Laparoscopic pectopexy effective in treating apical prolapse with low recurrence rates: Study
Apical prolapse, also known as uterine or vaginal vault prolapse, affects 6–8% of adult women, particularly postmenopausal women. It results from weakened pelvic floor support, leading to the descent of the uterus or vaginal vault into or outside the vaginal canal. This condition can severely impact a woman's quality of life, causing discomfort, urinary and bowel dysfunction, and sexual difficulties. Several factors increase the risk, including vaginal childbirth, previous prolapse, advanced preoperative prolapse stages (3 or 4), higher parity, heavier birthweight, older age, elevated BMI, and pelvic floor muscle defects.
Surgical intervention is often necessary for significant cases of apical prolapse. Pectopexy is one such procedure, aiming to restore the normal position of the uterus or vaginal vault by attaching it to pelvic ligaments or the abdominal wall using mesh for reinforcement. Laparoscopic pectopexy, a minimally invasive approach, uses small incisions and specialized instruments to perform the procedure with real time visualization. Compared to traditional open surgery, this method offers benefits such as reduced postoperative pain, shorter hospital stays, quicker recovery, and improved cosmetic results. It also allows for more precise mesh placement, potentially reducing the risk of recurrence and blood loss, and may be safer for patients with comorbidities that complicate open surgery. In contrast, open surgical techniques involve larger incisions for direct access to pelvic structures and are generally associated with longer recovery times.
Comparative studies on laparoscopic pectopexy and other surgical methods like sacrocolpopexy have shown mixed results. While both are effective in managing prolapse, laparoscopic pectopexy has demonstrated advantages in reducing urinary incontinence, postoperative pain, and hospitalization duration in some studies. Nevertheless, all surgical options carry risks such as infection, bleeding, mesh related complications, and injury to surrounding organs.
Given the variety of surgical approaches and their associated outcomes, the choice of procedure should be guided by individual patient characteristics, surgeon expertise, and patient preferences. To support evidence-based decision-making, authors conducted a systematic review to compare the effectiveness and outcomes of laparoscopic pectopexy with other surgical interventions for apical prolapse. This review’s findings would inform surgical practice and enhance the quality of patient care.
A comprehensive search was conducted in major medical databases for studies comparing laparoscopic pectopexy and other surgical techniques for apical prolapse management. Outcome measures included apical prolapse recurrence rates, intraoperative and post-operative complications, operation time, patient reported outcomes, and quality of life assessments. A total of 11 studies were included in this systematic review.
Laparoscopic pectopexy is a relatively new technique for treating apical prolapse, using laparoscopic instruments and a polypropylene mesh to securely reattach the vaginal vault or the uterus with the help of lateral parts of the iliopectineal ligament. Though laparoscopic pectopexy has gained popularity as a minimally invasive approach, it is essential to consider its benefits and compare them to other surgical options to determine the most suitable treatment for each patient. This systematic review compared laparoscopic pectopexy with other surgical interventions used to treat apical prolapse
This systematic review found that laparoscopic pectopexy was effective with less perioperative blood loss, shorter hospital stays, a quicker recovery process, and better post-operative quality of life. These findings were also reported in previous studies confirming that. These might be attributed to the laparoscopic approach resulting in smaller incisions, leading to less tissue trauma, reduced risk of infection, and quicker healing, resulting in cost savings and increased patient satisfaction. This approach also allows less post-operative pain and faster recovery compared to traditional open surgeries.
Laparoscopic pectopexy is a promising surgical method for apical prolapse, offering the benefits of minimally invasive surgery, reduced post-operative pain, and faster recovery times. However, other surgical methods, such as vaginal colpopexy and sacrocolpopexy, have their own advantages and may be more suitable for certain patients or specific clinical scenarios. Ultimately, the surgical method should be chosen based on individual patient characteristics, the severity of the prolapse, and the surgeon's expertise to achieve the best possible outcome for each patient.
Source: AlZiyadi / Indian Journal of Obstetrics and Gynecology Research 2025;12(3):369–376
