Laparoscopic Meshless Lateral Suspension in Patients with Advanced Stage Pelvic Organ Prolapse. A Prospective Cohort Study with a Median 36-Month Follow-Up.

Introduction and hypothesis: Laparoscopic lateral suspension with mesh is an effective technique for apical prolapse repair. In this study, we aimed to evaluate the outcomes of meshless laparoscopic lateral suspension in patients with advanced stage pelvic organ prolapse.

Methods: This study was conducted prospectively on patients with apical defects who had stage 3 or greater pelvic organ prolapse. The cervix or vaginal cuff was below the hymen in all patients. POP-Q measurements were performed. Meshless laparoscopic suspension was performed with a nonabsorbable suture. Perioperative complications were also noted. The patients were followed up. Late postoperative results at 36 months were noted. Objective cure was defined as POP-Q stage < II in any compartment. Objective cure rate and pelvic organ prolapse quantification system score were the main outcome measures.

Results: A total of 32 patients were included in the study. The mean age was 54.97 ± 13.31 years. Laparoscopic meshless suspension was performed in all patients under general anesthesia. Total laparoscopic hysterectomy was performed in 25 patients (78.1%). Other concomitant procedures were uterosacral ligament plication, laparoscopic cystocele repair, retropubic TVT, BURCH colposuspension, and posterior colporaphy. The median pelvic organ prolapse quantification score was significantly lower at 36 months postoperative. We calculated the objective cure rate for meshless laparoscopic lateral suspension for apical defects to be 81.3% at the 36-month follow-up.

Conclusions: Laparoscopic meshless lateral suspension is a novel technique with promising initial results that require further evaluation.