Pectopexy for Pelvic Organ Prolapse: A Scoping Review.

Abstract

Introduction and hypothesis: Pectopexy is an emerging surgical technique for apical pelvic organ prolapse, anchoring the prolapsed structure to the iliopectineal ligament. This review aims to systematically map the available evidence on pectopexy, including study characteristics, surgical techniques, and reported outcomes.

Methods: A systematic search was conducted across PubMed, Scopus, CENTRAL, CINAHL, LILACS, ClinicalTrials.gov, ProQuest, and OpenGrey, alongside citation searches. Eligible studies included those assessing pectopexy for apical pelvic organ prolapse (POP-Q stage ≥ 2). Randomised controlled trials (RCTs), cohort studies, and descriptive studies were included, while case reports and reviews were excluded. Study selection and data extraction were independently conducted by two reviewers, with findings summarised through descriptive synthesis.

Results: Thirty studies (2715 women) were eligible, which included four RCTs (13.3%), 10 cohort studies (33.3%), and 16 descriptive studies (53.3%). Most studies were conducted in Asia (66.7%), high-income economies (46.7%), and in tertiary care centres (86.7%). Pectopexy was primarily performed laparoscopically (86.7%), with bilateral fixation (86.7%) and using polypropylene mesh (46.7%). Eighty-five unique outcomes were reported. Commonly reported perioperative outcomes included operative time (86.7%), blood loss (50.0%), and length of hospital stay (50.0%). Recurrence of apical prolapse (90.0%), stress urinary incontinence (60.0%), and complications related to fixation material (53.3%) were frequently documented. No studies reported recurrence of prolapse symptoms, and the most frequent patient-reported outcome measure (PROM) was P-QOL (23.3%).

Conclusions: The reported pectopexy procedures and outcomes were heterogeneous. Current evidence is limited, particularly from RCTs and low-resource settings. Subjective outcomes and PROMs were underreported.