Comparative Outcomes of Mesh-Based and Mesh-Free Laparoscopic Uterus-Preserving Pectopexy for Apical Prolapse: A Retrospective Cohort Study.

Abstract

<h4>Aim</h4>To compare the anatomical and functional outcomes of mesh-based and mesh-free laparoscopic uterus-preserving pectopexy in patients with apical pelvic organ prolapse: METHODS: This retrospective cohort study included 81 patients who underwent either mesh-based (n = 41) or mesh-free (n = 40) laparoscopic pectopexy between 2021 and 2024. Patients were evaluated for operative time, estimated blood loss, hospital stay, anatomical success based on the POP-Q system, sexual function using the PISQ-12 questionnaire, and postoperative complications. Follow-up assessments were conducted at 6 weeks and 1 year for anatomical outcomes (POP-Q) and at 3 months and 1 year for sexual function (PISQ-12).<h4>Results</h4>Both techniques significantly improved POP-Q parameters and PISQ-12 scores. The mesh group demonstrated superior apical and posterior support (C, Ap, and Bp points), while the mesh-free group showed longer total vaginal length. Operative time was significantly longer in the mesh-free group. Sexual function improved in both groups, with a greater early improvement in the mesh group, though differences leveled at 1 year. Complication and recurrence rates were low and comparable between groups.<h4>Conclusions</h4>Mesh-based and mesh-free pectopexy both offer effective anatomical correction and functional recovery in apical prolapse surgery. Mesh-based techniques provide stronger apical support, while mesh-free approaches may be preferable for patients avoiding synthetic implants. Individualized surgical planning remains essential.