Objective To evaluate the perioperative safety and mid-term outcomes of laparoscopic sacrocolpopexy (LSC) and laparoscopic pectopexy (LP) for pelvic organ prolapse (POP).

Methods A retrospective analysis was conducted on 274 POP patients, including 178 who underwent LSC and 96 who underwent LP, between August 2017 and January 2023. The extent of prolapse and anatomical restoration were assessed preoperatively and postoperatively using the Pelvic Organ Prolapse Quantification (POP-Q) system. Quality of life outcomes were evaluated with validated questionnaires, including Pelvic Floor Distress Inventory-short form 20 (PFDI-20), Pelvic Floor Impact Questionnaire-short form 7 (PFIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12). Postoperative patient satisfaction was assessed during follow-ups. Postoperative anatomical restoration, perioperative status, and postoperative complications, recurrence, and quality of life were compared between the two groups. Multivariate logistic regression was performed to identify postoperative risk factors for recurrence.

Results The operative time in the LSC group was significantly shorter than that in the LP group (P < 0.05). Intraoperative blood loss was higher in the LSC group compared to that in the LP group (P < 0.05). The LSC group also exhibited higher rates of de novo stress urinary incontinence and constipation (P < 0.05). The mean follow-up duration was (35.91 ± 16.90) months. The positions of the indicator points (Aa, Ba, C, Ap, and Bp) in the POP-Q classification after the operation were all better than those before the operation. The PFDI-20 score, PFIQ-7 score, and PISQ-12 score all improved compared to those before the operation (P < 0.05). Comparison of preoperative and postoperative PFDI-20, PFIQ-7, and PISQ-12 scores showed no intergroup differences. Compared with the LP group, the LSC group had the lower preoperative POP-Q measurements at points Aa and Ba (P < 0.05), but superior postoperative measurements for all the indicator points (Aa, Ba, C, Ap, and Bp) (P < 0.05). Recurrence occurred in 28 cases in the LP group and 4 cases in the LSC group, with the LP group presenting a significantly higher anatomical recurrence rate than the LSC group did (31.46% 28/89 vs. 2.41% 4/166, P < 0.05). The subjective cure rate (100%) and objective cure rate (97.59%) in the LSC group were superior to those in the LP group (88.76% and 68.54%, respectively; P < 0.05). The results of the multivariate logistic regression analysis showed that, after adjusting for the confounding factors, including age, gravidity, parity, body mass index, and duration of POP, the risk of recurrence after LSC surgery was 0.044 times that after LP (odds ratio OR, 0.044; 95% CI, 0.015-0.133; P < 0.001).

Conclusion Mid-term outcomes of LP with partial cervical preservation appear inferior to those of LSC, with LSC demonstrating superior anatomical restoration and lower rates of anatomical recurrence. However, improvements in sexual function and quality of life are comparable between the two procedures. Further evaluation with larger sample sizes and longer follow-up is warranted to better characterize long-term outcomes.