Comparing Surgical Outcomes in Laparoscopic Sacral Hysteropexy with or without Retroperitoneal Tunneling

To evaluate the effectiveness and impact of the retroperitoneal tunneling technique on the surgical time and outcomes of laparoscopic sacral hysteropexy (SHP) for treating pelvic organ prolapse (POP).

This is a retrospective single-center cohort study in a tertiary referral center. Thirty-two consecutive patients underwent laparoscopic SHP for apical prolapse between 2016 and 2023. Laparoscopic SHP with or without right pelvic side wall retroperitoneal tunneling. The primary outcome was surgical time. Secondary outcomes included blood loss, intra-and postoperative complications, length of hospital stay, postoperative pain scores, and improvement in POP quantification (POP-Q) scores. Statistical analyses were performed using t-tests and multiple regression. Statistical significance was set at P < .05.

The tunneling group (n = 14) demonstrated significantly shorter surgical times than the nontunneling (n = 18) group (60.79 ± 22.35 minutes vs 98.06 ± 26.28 minutes, P < .001). There were no significant differences between the groups regarding blood loss, intra-and postoperative complications, length of hospital stay, pain scores, or point-C positions during 3 months and 1 year of follow-up. Multiple regression analysis confirmed a significant reduction in surgical time in the tunneling group after adjusting for confounders (-62.36 minutes [95% confidence interval (CI) = -102.7, -21.99, P = .0038]).

The retroperitoneal tunneling technique in laparoscopic SHP significantly reduces the surgical time without increasing the risk of complications. These findings suggest that tunneling is a safe and efficient method that can be routinely adopted for SHP.