Laparoscopic Sacropexy Versus Vaginal Sacrospinous Fixation for Pelvic Organ Prolapse: A Retrospective Comparison of Surgical Outcomes and Quality of Life.

Background

Pelvic organ prolapse (POP) significantly impacts women's quality of life. Two established surgical approaches exist: laparoscopic sacropexy (LSC) and vaginal sacrospinous fixation (SSLF). This study compared surgical outcomes, complication rates, and quality of life between these techniques.

Methods

This retrospective monocentric study included 58 patients treated between 2020 and 2023: 41 underwent LSC, and 17 underwent SSLF with vaginal hysterectomy. All procedures were performed by a single surgeon. Primary outcomes included operative time, complications, and hospital stay. Quality of life was assessed using the German Pelvic Floor Questionnaire (Deutscher Beckenboden-Fragebogen), King's Health Questionnaire (KHQ), and patient satisfaction surveys.

Results

Patient groups differed significantly in ASA scores (p = 0.023) and comorbidities, with SSLF patients showing higher morbidity. LSC demonstrated longer operative times (91 (75-115) vs. 73 (61-87) min, p = 0.05) but significantly fewer complications (0% vs. 17.6%, p = 0.02). Both methods showed significant improvements in bladder function, prolapse symptoms, and pelvic floor dysfunction scores (all p < 0.001). A within-group improvement in sexual function scores was observed in the LSC group (p = 0.002) but not in the SSLF group (p = 0.5); the between-group comparison of change scores was not significant (p = 0.8). No significant differences were found between groups regarding hospital stay duration or overall patient satisfaction (LSC: 95% vs. SSLF: 87% satisfied, p > 0.05).

Conclusions

Both surgical approaches effectively treat POP with high patient satisfaction. LSC was associated with fewer observed complications and a within-group improvement in sexual function scores; SSLF was associated with shorter operative time and was applied in patients with higher morbidity. These associations may partly reflect baseline differences between groups and are considered hypothesis-generating. SSLF remains suitable for patients with higher morbidity when minimizing operative time and avoiding Trendelenburg positioning is advantageous.