Balanced Sacrospinous Ligament Fixation in Uterine Prolapse: A Preliminary Retrospective Comparative Study

This study aimed to evaluate the short-term clinical efficacy of balanced sacrospinous ligament fixation (BSSF) in comparison with laparoscopic sacrohysteropexy (LSH) and modified sacrospinous fixation (MSSF) in patients with uterine prolapse.

A retrospective cohort study was conducted involving patients diagnosed with stage II or higher uterine prolapse who underwent either BSSF, MSSF, and LSH at a tertiary teaching hospital during the period spanning June 2021 to June 2024. The primary outcome was 1-year subjective recurrence rate. The secondary outcomes were anatomic recurrence, estimated blood loss, operative time, blood transfusion, injuries, hospital stays, catheter indwelling days, postoperative complications, pelvic organ prolapse quantification scores, and quality of life assessment. Multivariable regression adjusted for age, menopausal status, parity, BMI, surgical approach, and baseline POP-Q stage.

A total of 152 patients were included (LSH 51, MSSF 52, BSSF 49), with comparable baseline characteristics. The 1-year subjective recurrence rate was significantly lower in the BSSF (2.0%) and LSH (2.0%) groups than in the MSSF group (13.5%) (p = 0.023). Anatomical recurrence showed a similar pattern (BSSF 4.1%, LSH 7.8%, MSSF 19.2%; p = 0.034). Operative time was shorter for BSSF (median 75 min) and MSSF (median 57 min) than LSH (median 140 min, p < 0.05), with no differences in blood loss or hospital stay. At 3-12 months postoperatively, BSSF demonstrated better anterior compartment support than MSSF (p < 0.05), comparable to LSH.

BSSF seems to be a safe and effective uterine-sparing option for apical prolapse, further randomized controlled trials with longer follow-up are needed.