Laparoscopic sacrocolpopexy, transvaginal mesh and lateral suspension are effective at improving quality of life in patients with advanced apical prolapse

1. In a cohort of women with advanced apical prolapse, laparoscopic sacrocolpopexy (LSC), transvaginal mesh (TVM), and lateral suspension (LLS) were all effective at improving patients’ anatomy and quality of life. 

Evidence Rating Level: 2 (Good) 

Pelvic organ prolapse (POP) involves the descent of pelvic organs due to a weakened pelvic floor. Apical prolapse, which includes the vaginal vault or uterus, is a complex form often requiring surgery in advanced cases. This retrospective cohort study compares the safety and effectiveness of laparoscopic sacrocolpopexy (LSC), transvaginal mesh (TVM), and lateral suspension (LLS), three different surgical techniques for POP. Quality of life (QoL) was measured by the Pelvic Floor Distress Inventory Questionnaire (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-20). A total of 98 participants with stage III-IV POP were included in the study. Among those, 35 underwent LSC, 34 underwent TVM, and 29 underwent LLS. Patients who underwent LLS experienced the best surgical outcomes, including the shortest operation time (3.07±0.15 hours vs. LSC: 4.59±0.13 hours, p<0.05), minimal blood loss (64.48±4.62 mL vs. TVM: 116.18±8.10 mL, p<0.05), and shorter hospital stays (5.17±0.20 days vs. TVM: 6.21±0.27 days, p<0.05). All three groups experienced similar complication rates. Postoperative measurements showed significant improvement in pelvic anatomy in all surgical groups (p<0.001), with no signs of apical prolapse recurrence in 2 years of follow-up. Additionally, each group had improvements in QoL. Specifically, patients who underwent TVM surgery with uterine preservation reported significantly better QoL (by way of PFIQ-7 scores) than those who had a hysterectomy (0.96 ± 0.52 vs. 6.60 ± 3.46, p <0.05). Overall, in women with apical POP, undergoing surgery with LSC, TVM, and LLS resulted in significant anatomical restoration and improved quality of life. LLS had the most favourable perioperative outcomes, while TVM with uterine preservation was associated with the best patient-reported quality of life. 

Click to read the study in PLOS One

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