Ten Years of Laparoscopic Pectopexy: A Case Series Analysis

Pelvic organ prolapse (POP) often causes significant urinary, bowel, pain, and sexual symptoms, and treatment success is increasingly defined by symptom relief rather than anatomical correction alone. Long-term outcome data for laparoscopic pectopexy (LP) remain limited.

We conducted a retrospective cohort study of all women undergoing multicompartment POP repair with LP and native tissue repair of level 2 and 3 defects at a tertiary referral center between 2010 and 2019. The primary outcome was prolapse recurrence, defined as POP-Q stage II or higher. Secondary outcomes included de novo POP, surgical reoperation, and complications. Time-to-event outcomes were analyzed with Kaplan-Meier survival curves to estimate freedom from recurrence and freedom from reoperation.

A total of 832 patients were included (median age of 63 years). Median recurrence-free survival was 9.34 years (IQR 7.36-10.60), and median reoperation-free survival was 9.56 years (IQR 7.68-10.71). Most events (87.9%) occurred within 4 years. Surgical reoperation was required in 81 patients (9.7%), also clustering in the first 4 years. Apical re-fixation achieved a 94.9% long-term success rate over 10 years. Logistic regression identified lateral defect severity as the strongest predictor of failure (p < 0.001), whereas demographic factors and prior surgery had minimal impact.

LP with defect-oriented native tissue repair provides durable apical support with a low 10-year reoperation rate. Most clinically relevant failures occur within 4 years, supporting follow-up of this duration. Addressing lateral defects during initial surgery is critical for optimizing long-term outcomes.