Comparison of Open Abdominal and Laparoscopic Bilateral Uterosacral Ligament Replacement: A One-Year Follow-Up Study

Abstract

Background: Pelvic organ prolapse significantly affects women’s health, often requiring surgery. Unilateral sacrocolpopexy (SCP) is the gold standard for apical prolapse repair. However, varied SCP techniques can lead to inconsistencies in clinical outcomes, with differences in synthetic materials, mesh dimensions, placement, and apical tensioning. This variability may impact the comparability of clinical outcomes. Bilateral apical fixation has gained attention for its potential to provide effective apical support and restore anatomical integrity. Objective: To date there are not many studies on bilateral apical cervicosacropexy between the vaginal apex and the sacrum at the level of S1/promontory with one-year follow-up. Methods: This study presents a one-year follow-up comparing the clinical outcomes of open abdominal (CESA) and laparoscopic cervicosacropexy (laCESA) for bilateral apical suspension in women with pelvic floor disorders. A total of 145 women underwent either CESA (n = 75) or laCESA (n = 70) using a surgical technique with a designed polyvinylidene-fluoride (PVDF) mesh of defined shape replacing both uterosacral ligaments. Outcomes were efficacy, safety, and success rates of both surgical approaches in restoring apical vaginal support and pelvic floor functioning. Results: Both techniques demonstrated high efficacy of apical prolapse repair and a high level of safety. While comparable rates of urinary continence restoration were achieved, laCESA showed significant advantages in terms of operative time, hospital stay, and recovery time. Conclusions: These findings demonstrate the reproducibility of a surgical technique including clinical outcomes in the treatment of pelvic floor dysfunction. The standardization of mesh design and surgical methodology enhances reproducibility and may mitigate some of the variability associated with clinical outcomes in apical mesh fixation techniques.