Pelvic organ prolapse (POP) remains a significant health concern, with an increasing global trend toward uterine preservation in surgical management. While laparoscopic sacrohysteropexy (SHP) is an established uterine-preserving alternative to the gold-standard sacrocolpopexy, laparoscopic pectopexy has recently emerged as a novel suspension technique. Although many studies have compared pectopexy with sacrocolpopexy, there is a lack of direct, head-to-head comparisons between pectopexy and SHP—the two primary options for apical suspension with uterine preservation. This study aims to evaluate the surgical efficiency and clinical outcomes of these two techniques to determine their respective roles in modern prolapse surgery.

We conducted a retrospective cohort study of 170 women who underwent surgical treatment for POP at National Taiwan University Hospital between 2019 and 2025. Patients were divided into two groups: those receiving laparoscopic pectopexy (n=85) and those receiving sacrohysteropexy (n=85). Objective outcomes were assessed using the POP-Q system at baseline and at 1, 3, 6, and 12 months postoperatively. The primary outcome was objective surgical failure, defined as any compartment descent beyond POP-Q stage I. Secondary outcomes included operation time, estimated blood loss, and patient-reported quality-of-life scores via PFDI-20 and PGI-I scale

Pectopexy was associated with a significantly shorter mean operation time (154.3±39.8 min vs. 179.3±36.3 min, p < 0.001) and reduced blood loss  compared to SHP. At 12 months, the cumulative objective success rate was 83.8% for pectopexy and 91.3% for SHP (p = 0.26). While SHP showed a longer total vaginal length (TVL) at 1 month (8.5±0.9 cm vs. 8.0 ±0.8 cm, p < 0.001), this difference became insignificant by 12 months. Compartmental analysis revealed that for the 12 pectopexy patients with recurrence, 7 occurred in the anterior compartment, 2 in the apical, and 4 in the posterior compartment. In contrast, SHP recurrences were fewer and predominantly anterior. Pectopexy patients had higher urinary complication rates (7%) compared to SHP (2.4%), whereas SHP was linked to rare risks like discitis and vessel injury.

The results demonstrate that pectopexy achieves surgical efficiency by utilizing the pectineal ligament, which is more readily accessible than the sacral promontory and avoids extensive dissection of the presacral space. This approach mitigates the risk of rare but severe complications such as discitis and presacral venous hemorrhage, which were observed in the SHP group. Although pectopexy showed equivalent 12-month anatomic success, the compartmental analysis suggests that surgeons should pay meticulous attention to the strength of mesh-cervix anchoring to minimize anterior and apical descent.

Laparoscopic pectopexy is a safe and effective alternative to sacrohysteropexy, offering significantly shorter operative times and reduced blood loss with comparable 12-month anatomic and subjective outcomes. While recurrence patterns vary slightly between the two procedures, both provide high patient satisfaction and robust quality-of-life improvements.

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