FIVE-YEAR ANATOMICAL AND FUNCTIONAL OUTCOMES OF LAPAROSCOPIC SACROCOLPOPEXY VERSUS NATIVE TISSUE REPAIR FOR ADVANCED PROLAPSE

Dr. Noor Abadi; MBBS; Prof. Tariq Hussain; MD

Abstract

Pelvic organ prolapse (POP) significantly impairs the quality of life for millions of women globally, yet the debate persists regarding the optimal surgical approach for long-term durability. This longitudinal cohort study evaluates the five-year clinical and anatomical outcomes of 450 patients undergoing either transvaginal native tissue repair (NTR) or laparoscopic sacrocolpopexy (LSC). While surgical intervention remains the gold standard for symptomatic Stage II-IV prolapse, recurrence rates and secondary complications such as dyspareunia and mesh erosion necessitate rigorous long-term follow-up. Our data demonstrate that while both techniques offer significant initial improvement, LSC provides superior anatomical longevity, particularly in the apical compartment. However, these benefits are offset by longer operative times and specific mesh-related risks. Conversely, NTR maintains a favorable profile for older populations with multiple comorbidities due to shorter anesthesia exposure. This abstract details the comparative effectiveness, patient-reported outcome measures (PROMs), and reoperation rates over a 60-month period, providing critical evidence for personalized surgical counseling in urogynecological practice. The findings emphasize the necessity of balancing anatomical success with functional quality of life and long-term safety profiles in pelvic floor reconstructive surgery.

Keywords: Pelvic Organ Prolapse, Laparoscopic Sacrocolpopexy, Urogynecology, Surgical Outcomes, Native Tissue Repair, Quality of Life, Mesh Complications, Long-term Follow-up

As the aging female population grows, the demand for durable surgical solutions for pelvic organ prolapse (POP) has reached an unprecedented peak. Pelvic floor disorders affect approximately 25% of women, with a lifetime risk of undergoing surgery for prolapse or incontinence reaching 20% by age 80. The high rate of recurrence (30% in some historical series) and the controversy surrounding transvaginal mesh have left clinicians and patients in a state of uncertainty regarding the most reliable long-term interventions. This study addresses a critical gap in the literature by providing high-quality, five-year comparative data on native tissue versus laparoscopic mesh-based repairs. By quantifying the trade-offs between anatomical longevity and functional complications, our findings assist surgeons in optimizing procedural selection. This research directly supports the AAMS mission of improving maternal and reproductive health by refining surgical standards and enhancing the long-term quality of life for women suffering from pelvic floor dysfunction.

The primary objective of this study was to compare the five-year anatomical success rates and patient-reported functional outcomes between laparoscopic sacrocolpopexy and native tissue repair in women with advanced symptomatic pelvic organ prolapse.

We conducted a prospective, comparative cohort study of 450 women (mean age 62.4 years) diagnosed with Pelvic Organ Prolapse Quantification (POP-Q) Stage II–IV. Participants were non-randomly assigned to either Laparoscopic Sacrocolpopexy (LSC, n=210) or Transvaginal Native Tissue Repair (NTR, n=240) based on clinical indications and patient preference. Follow-up assessments occurred at 6, 12, 24, and 60 months postoperatively. Anatomical success was defined as POP-Q Stage <II in all compartments. Functional outcomes were measured using the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Reoperation rates for recurrence or complications were tracked via electronic health records and physical examination. Statistical analysis utilized Chi-square tests for categorical variables and independent t-tests for continuous data, with a Cox proportional hazards model used to determine the risk of recurrence over time. Significance was set at p<0.05.

At the 60-month follow-up, the anatomical success rate was significantly higher in the LSC group (88.6%) compared to the NTR group (75.8%; p=0.002; OR 2.45, 95% CI 1.48–4.05). Apical recurrence was observed in 4.3% of LSC patients versus 14.2% in the NTR cohort (p<0.001). Total PFDI-20 scores improved significantly in both groups (p<0.001 baseline vs. 5 years), though LSC patients reported higher satisfaction with vaginal bulge symptoms (8.1 vs. 12.4, p=0.015). Reoperation for prolapse recurrence was required in 3.8% of the LSC group and 11.7% of the NTR group (HR 0.32, 95% CI 0.14–0.71). Mesh erosion occurred in 2.8% of LSC cases, requiring surgical revision in 1.4%. De novo dyspareunia was reported more frequently in the LSC group (7.6%) compared to the NTR group (3.3%, p=0.04). No significant difference was noted in the incidence of postoperative stress urinary incontinence between the two modalities (15.2% vs. 17.1%, p=0.58).

Laparoscopic sacrocolpopexy (LSC) demonstrates clinical superiority over native tissue repair (NTR) regarding five-year anatomical durability, specifically for apical and multicompartment prolapse. Despite the increased complexity of the laparoscopic approach, the significantly lower reoperation rate for recurrence justifies its use in younger, sexually active patients. However, the higher incidence of de novo dyspareunia in the LSC group emphasizes the need for careful preoperative counseling. Native tissue repair remains a valid and effective intervention for women prioritizing shorter recovery and reduced mesh-related risks. Ultimately, surgical selection should be individualized, utilizing a shared decision-making model that weighs the 12.8% gain in anatomical success against the specific complication profiles of each modality. Long-term surveillance remains essential to monitor for late-onset mesh complications and late-stage recurrence.