Comparing the Efficacy of Laparoscopic Pectopexy and Laparoscopic Sacrocolpopexy for Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis

Abstract

Objective: To assess and compare the efficacy of laparoscopic pectopexy and laparoscopic sacrocolpopexy in managing pelvic organ prolapse.

Data sources: A systematic search of PubMed, Web of Science, Scopus, and Embase was conducted on July 3, 2024, using the search terms "Pectopexy" AND "Laparoscop*" with no publication date restrictions. Additional sources included citation screening and searches in Google Scholar and ProQuest.

Methods of study selection: We included all peer-reviewed, English full-text articles comparing intraoperative, short-term (up to 6 months), or long-term (6 to 12 months) outcomes for laparoscopic pectopexy and sacrocolpopexy in pelvic organ prolapse management.

Tabulation, integration, and results: Our electronic search identified 269 records, of which 11 were deemed eligible after thorough screening. No additional eligible articles were found through a manual search. The final review included 11 studies, comprising 1043 patients across 4 randomized controlled trials, 6 retrospective studies, and one prospective cohort. Meta-analyses using a random-effects model showed lower operation time (Hedges's g = -0.978 [-1.629, -0.327]; p = .003) and blood loss (Hedges's g = -0.658 [-1.160, -0.155]; p = .010) in pectopexy, with comparable organ injury rates (p > .05) between procedures. Short-term results showed a shorter hospitalization duration for pectopexy (Hedges's g = -0.213 [-0.426, -0.000]; p = .049), while post-surgery outcomes like urinary tract infection, and voiding dysfunction were similar across groups (p > .05). All long-term outcomes were comparable, including apical prolapse recurrence, mesh-related complications, pelvic organ prolapse quantification system scores, constipation, urgency, stress urinary incontinence, dyspareunia, and patient satisfaction (p > .05).

Conclusion: This review highlights that laparoscopic pectopexy, despite its theoretical technical advantages, shows comparable intraoperative organ injury rates and similar urinary, defecation, and sexual function outcomes to laparoscopic sacrocolpopexy. However, pectopexy is linked to shorter operative times, less blood loss, and reduced post-operative hospitalization.

Keywords: Iliopectineal ligament; Urinary incontinence, Urogenital prolapse, Vaginal vault prolapse.