Comparison of Arcus Tendineus Fascia Pelvis Versus Sacrospinous Ligament Suspension at the Time of Hysterectomy for Apical Pelvic Organ Prolapse.

Introduction and hypothesis: This retrospective cohort study was aimed at comparing two native tissue suspension techniques for correcting apical pelvic organ prolapse (POP): sacrospinous ligament suspension (SSLS) and arcus tendineus fascia pelvis suspension (ATFPS).

Methods: Medical charts of 145 patients who underwent one of the two techniques for symptomatic uterine prolapse at two academic centers from 2017 to 2022 were reviewed. The success rate of each surgery, along with the risks of complications, pain, and urinary and bowel symptoms were evaluated.

Results: Mean postoperative follow-up time was 42.4 ± 9.1 weeks. No significant differences in baseline characteristics were noted. Anatomical objective recurrence (POP-Q ≥ stage 2 POP in any compartment) was more prevalent following SSLS (SSLS 49.0%, AFTPS 23.4%; p = 0.005), with nearly all recurrences being anterior. There were no differences in resolution of apical prolapse. Subjective recurrence, defined as prolapse symptoms of vaginal bulge and pressure, also occurred at a higher rate post-SSLS (SSLS 22.4%, AFTPS 8.2%; p = 0.019). Postoperative buttock pain at 6 weeks was more common post-SSLS (SSLS 18.2%, AFTPS 1.6%; p = 0.006). Overall, reoperation for POP recurrence and/or incontinence occurred in 8.2% of SSLS and 3.1% of ATFPS (p = 0.222).

Conclusions: In the short term, ATFPS exhibited lower subjective and objective POP recurrence rates and less early postoperative pain compared with standard SSLS at the time of hysterectomy for POP.