Comparative Effectiveness of Laparoscopic Lateral Suspension, Pectopexy and Sacrocolpopexy for Apical Pelvic Organ...

The objective was to compare anatomical and safety outcomes of laparoscopic lateral suspension (LS), pectopexy (PP), and sacrocolpopexy (SCP) for apical pelvic organ prolapse (POP) in a retrospective comparative cohort using propensity score weighting. The cohort consisted of consecutive women undergoing LS, PP or SCP at a tertiary referral centre between 2017 and 2023.

Confounding by indication was addressed using a multinomial propensity score with inverse probability of treatment weighting; covariate balance was assessed by standardised mean differences. Weighted regression models with robust standard errors were used; primary-outcome pairwise comparisons were Holm corrected. Sensitivity analyses included overlap weighting, entropy balancing and doubly-robust estimation. The main outcome measures were 12-month apical anatomical success; perioperative outcomes; Clavien-Dindo complications; mesh-related events; reoperation; time to recurrence.

Of 188 women (58 with SCP, 63 with PP, 67 with LS), 12-month apical success was 74.1%, 73.0%, 80.6%, with no significant pairwise differences (PP vs SCP: aOR 0.80, 95% CI 0.33-1.93; LS vs SCP: aOR 1.42, 95% CI 0.56-3.60; global p = 0.437). Post hoc analysis indicated 80% power only for large effects (≈18 percentage points). LS required longer operative time (+44.2 min, p < 0.001); PP had modestly higher blood loss (+23.6 ml, p = 0.038). Complications, mesh exposure, reoperation and time-to-recurrence did not differ. Findings were robust across sensitivity analyses.

No significant differences in 12-month apical success or safety were detected among women undergoing SCP, PP or LS after adjustment; LS required a longer operative time. Wide confidence intervals and absence of a prespecified non-inferiority margin preclude any equivalence claim; short-term findings cannot be extrapolated to long-term durability.