Related Experiment Video
Updated: Jul 16, 2026
Laparoscopic Non-Mesh Cerclage Pectopexy with Uterine Preservation for Pelvic Organ Prolapse
Published on: October 25, 2024
Beyond mesh: comparison of mesh-free sacropexy techniques for pelvic organ prolapse
Manuela Maletta1, Antonio Raffone2, Paola Mete1
1Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Study Objective:
To compare long-term recurrence outcomes of three laparoscopic mesh-free sacropexy procedures performed according to the Bologna technique, including sacropexy using Ti-Cron suture.
Design:
An observational, retrospective, cohort study.
Setting:
a tertiary referral hospital.
Patients:
consecutive patients diagnosed with pelvic organ prolapse stage ≥2 according to the Pelvic Organ Prolapse Quantification (POP-Q) system, who underwent laparoscopic sacropexy without mesh between January 1, 2011, and December 31, 2021 were included. Exclusion criteria were: age >80 years, previous pelvic organ prolapse surgery and lack of clinical follow-up data.
Interventions:
laparoscopic sacropexy were classified into three surgical subgroups: hysterosacropexy (LSHP), cervicosacropexy (LSCP), and colposacropexy (LScP). A Ti-Cron suture was anchored to the anterior longitudinal ligament of the sacrum, the right uterosacral ligament was progressively plicated, and the suture was incorporated into the uterus, cervix, or vaginal vault according to the surgical procedure. The suture was then tied in a tension-free manner to achieve adequate apical suspension.
Measurements And Main Results:
During the study period, 81 (67%) patients were included in the study: 12 (15%) women in the LSHP group, 48 (59%) in the LSCP, 21 (26%) in the LScP. In multivariable Cox regression, LSHP was independently associated with a significantly lower risk of objective recurrence compared with LSCP. Advanced prolapse (POP-Q stage IV) was an independent predictor of recurrence. No other clinical or surgical variables were significantly associated with objective recurrence-free survival. Patient-reported outcomes significantly improved after surgery in all groups, with reductions in POPDI-6, UDI-6, and PFDI-20 scores. Subjective recurrence-free survival showed similar trends across surgical approaches.
Conclusions:
In an aging population with increasing demand for pelvic organ prolapse surgery, LSHP using non-absorbable braided polyester sutures appears to be a promising minimally invasive mesh-free surgical option, associated with a low risk of prolapse recurrence. However, larger prospective studies are needed to confirm these findings.
