Laparoscopic Pectopexy: An Effective Procedure for Pelvic Organ Prolapse with an Evident Improvement on Quality of Life

Comparing the Efficacy of Laparoscopic Pectopexy and Laparoscopic Sacrocolpopexy for Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis

OBJECTIVE

To assess and compare the efficacy of laparoscopic pectopexy and laparoscopic sacrocolpopexy in managing pelvic organ prolapse.

DATA SOURCES

A systematic search of PubMed, Web of Science, Scopus, and Embase was conducted on July 3, 2024, using the search terms "Pectopexy" AND "Laparoscop*" with no publication date restrictions. Additional sources included citation screening and searches in Google Scholar and ProQuest.

METHODS OF STUDY SELECTION

We included all peer-reviewed, English full-text articles comparing intraoperative, short-term (up to 6 months), or long-term (6 to 12 months) outcomes for laparoscopic pectopexy and sacrocolpopexy in pelvic organ prolapse management.

TABULATION, INTEGRATION, AND RESULTS

Our electronic search identified 269 records, of which 11 were deemed eligible after thorough screening. No additional eligible articles were found through a manual search. The final review included 11 studies, comprising 1043 patients across 4 randomized controlled trials, 6 retrospective studies, and one prospective cohort. Meta-analyses using a random-effects model showed lower operation time (Hedges's g = -0.978 [-1.629, -0.327]; p = .003) and blood loss (Hedges's g = -0.658 [-1.160, -0.155]; p = .010) in pectopexy, with comparable organ injury rates (p > .05) between procedures. Short-term results showed a shorter hospitalization duration for pectopexy (Hedges's g = -0.213 [-0.426, -0.000]; p = .049), while post-surgery outcomes like urinary tract infection, and voiding dysfunction were similar across groups (p > .05). All long-term outcomes were comparable, including apical prolapse recurrence, mesh-related complications, pelvic organ prolapse quantification system scores, constipation, urgency, stress urinary incontinence, dyspareunia, and patient satisfaction (p > .05).

CONCLUSION

This review highlights that laparoscopic pectopexy, despite its theoretical technical advantages, shows comparable intraoperative organ injury rates and similar urinary, defecation, and sexual function outcomes to laparoscopic sacrocolpopexy. However, pectopexy is linked to shorter operative times, less blood loss, and reduced post-operative hospitalization.

Effectiveness of Laparoscopic Pectopexy for Pelvic Organ Prolapse Compared with Laparoscopic Sacrocolpopexy

STUDY OBJECTIVE

To evaluate the clinical benefits of laparoscopic pectopexy vs laparoscopic sacrocolpopexy in women with pelvic organ prolapse (POP).

DESIGN

Prospective cohort study.

SETTING

A tertiary hospital.

PATIENTS

We included 203 patients with POP.

INTERVENTIONS

Laparoscopic pectopexy or laparoscopic sacrocolpopexy.

MEASUREMENTS AND MAIN RESULTS

Anatomic effectiveness was measured using the POP Quantification system, both before and after operation. Functional recovery effectiveness was evaluated using complications and recurrence rates within 1 year. Quality of life was assessed by the Pelvic Floor Distress Inventory-20 and Incontinence Quality of Life questionnaires at enrollment and postoperative months 3, 6, and 12. Comparisons between groups were performed using t test, chi-square test, and mixed-effects model with repeated measures. The analysis included 203 eligible patients (sacrocolpopexy, 101; pectopexy, 102). The proportion of robotic-assisted surgeries was lower in the pectopexy group than in the sacrocolpopexy group (15.7% vs 41.6%, p <.001). The average operation time of pectopexy was shorter than that of sacrocolpopexy (174.2 vs 187.7 minutes) with a mean difference of 13.5 minutes (95% confidence interval, 3.9-23.0; p = .006). Differences of intraoperative blood loss, length of hospital stay, and postoperative 7-day complications between groups were not significant. Anatomic successes were obtained in both groups with similar improvement in POP Quantification scores. The rate of urinary symptoms recurrence was higher in the pectopexy group (13.7%) than in the sacrocolpopexy group (5.0%) at the 1-year follow-up (odds ratio, 3.1; 95% confidence interval, 1.1-8.8, p = .032). The Pelvic Floor Distress Inventory-20 and Incontinence Quality of Life scores were better improved at postoperative months 3, 6, and 12 for laparoscopic pectopexy than for sacrocolpopexy.

CONCLUSION

Laparoscopic pectopexy revealed comparable anatomic success, shorter operation time, and better improvement in quality of life scores of prolapse, colorectal-anal, and urinary symptoms at 1-year follow-up, possibly being an alternative when sacrocolpopexy is not practicable. However, clinicians should pay more attention to the recurrence of urinary symptoms after pectopexy.

Quality of Life Following Pelvic Organ Prolapse Treatments in Women: A Systematic Review and Meta-Analysis

Introduction: Quality of life (QoL) improvement is one of the main outcomes in the management of pelvic organ prolapse as a chronic illness in women. This systematic review aimed to investigate the impact of surgical or pessary treatment for pelvic organ prolapse (POP) on quality of life. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was applied. Electronic databases, including PubMed, Scopus, and Web of Science, were searched for original articles that evaluated the QoL before and after surgical interventions or pessary in pelvic organ prolapse from 1 January 2012 until 30 June 2022 with a combination of proper keywords. Included studies were categorized based on interventions, and they were tabulated to summarize the results. Results: Overall, 587 citations were retrieved. Of these, 76 articles were found eligible for final review. Overall, three categories of intervention were identified: vaginal surgeries (47 studies), abdominal surgeries (18 studies), and pessary intervention (11 studies). Almost all interventions were associated with improved quality of life. The results of the meta-analysis showed a significant association between the employment of surgical approach techniques (including vaginal and abdominal surgeries) and the quality of life (Pelvic Floor Distress Inventory (PFDI) (MD: −48.08, 95% CI: −62.34 to −33.77, p-value < 0.01), Pelvic Floor Impact Questionnaire (PFIQ) (MD: −33.41, 95% CI: −43.48 to −23.34, p < 0.01)) and sexual activity of patients with pelvic organ prolapse (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ) (MD: 4.84, 95% CI: 1.75 to 7.92, p < 0.01)). Furthermore, narrative synthesis for studies investigating the effect of the pessary approach showed a positive association between the use of this instrument and improvement in the quality of life and sexual activity. Conclusions: The results of our study revealed a significant improvement in the women’s quality of life following abdominal and vaginal reconstructive surgery. The use of pessary was also associated with increased patient quality of life.

Perioperative and Long-Term Anatomical and Subjective Outcomes of Laparoscopic Pectopexy and Sacrospinous Ligament Suspension for POP-Q Stages II-IV Apical Prolapse

The aim of this paper was to analyze perioperative and long-term outcomes in 114 women undergoing surgery for POP-Q ≥ 2 apical prolapse: sacrospinous ligament colpo/hysteropexy (SSLF/SSHP)—61; laparoscopic pectopexy (LP)—53. Validated questionnaires (PGI-I, ISI, #35 EPIQ, PFIQ-7, PFDI-20) were completed at baseline and follow-up. POP-Q stages II, III and IV were diagnosed in 1 (0.9%), 84 (73.7%) and 29 (25.4%) patients, respectively. Mean operative time and hospital stay were 151.8 ± 36.2 min/2.6 ± 1.1 days for LP and 69 ± 20.4 min (p < 0.001)/2.7 ± 1.0 days for SSLF. Severe intraoperative complications occurred in two (1.8%) patients. Mean follow-up was 26.9 ± 12 and 37.3 ± 17.5 months for LP and SSLF, respectively. At follow-up, significant improvement for all POP-Q points was observed in both groups (p < 0.001). Shortening of total vaginal length was found in both groups, but predominantly in SSLF patients (p = 0.01). The sensation of vaginal bulge (EPIQ) was reduced, and total PFDI-20 and PFIQ-7 scores improved (p < 0.04) in both groups. Subjective success was reported by 40 (75.5%) LP and 44 (72.1%) SSLF patients. ISI detected no deterioration in urinary incontinence. PGI-I, PFDI-20, #35 EPIQ, PFIQ-7 and ISI did not differ between the groups. In conclusion both, SSLF and LP for apical prolapse generate good anatomical and subjective outcomes, with protective effect on the anterior compartment observed for LP.