Comparison of 1-year outcomes after uterine-preserving laparoscopic pectopexy using an inverted T-shaped mesh versus the horizontal DynaMesh: A retrospective, multicenter cohort study.

Abstract

<h4>Objective</h4>This study evaluates the safety and efficacy of uterine-preserving laparoscopic pectopexy (LP) and assesses whether anterior mesh extension influences surgical outcomes.<h4>Methods</h4>Eighty-four patients with advanced pelvic organ prolapse (POP-Q stage ≥2) were studied. Forty-two patients with advanced uterine and anterior vaginal prolapse underwent an innovative LP using an inverted T-shaped mesh (LP-T). The other 42 patients, with predominant uterine prolapse, received conventional LP using the horizontal DynaMesh (LP-D).<h4>Results</h4>Preoperatively, patient characteristics were comparable except for significantly higher stages of uterine and anterior vaginal prolapse in the LP-T group (P < 0.05). Perioperative outcomes were similar, except for significantly greater blood loss, higher pain scores, longer operating time, Foley catheter duration, and hospital stay in the LP-T group (P < 0.05). At 1 year, POP-Q stages and parameters improved significantly after both procedures, with satisfactory rates of anatomic cure (POP-Q stage <2) in the anterior (90.2% vs 92.9%), middle (80.5% vs 83.3%), and posterior (95.1% vs 97.6%) compartments (P > 0.05). Recurrent uterine prolapse was the most common site of prolapse recurrence. Both approaches yielded favorable functional outcomes, and overall surgical complication rates were low. Logistic regression identified two significant risk factors for recurrence: levator ani muscle avulsion (odds ratio [OR] 13.47, P = 0.002) and chronic constipation (OR 4.58, P = 0.03).<h4>Conclusion</h4>Our results suggest that both LP procedures are safe and effective. Levator ani avulsion and chronic constipation were found to significantly influence prolapse recurrence.