Laparoscopic pectopexy versus sacropexy for apical prolapse correction: The first randomized prospective controlled clinical trial

Introduction: Sacral colpopexy is a well established method of apical prolapse correction. Although this technique allows restoring the physiological axis of the vagina, it also bares some potential risks: An injury to the presacral venous plexus, a long term risk of de novo constipation, difficult surgical conditions in obese patients. We developed pectopexy, an alternative method to avoid the presacral preparation: The vagina or cervix is fixed in a hammock-like manner to both iliopectineal ligaments by the use of a synthetic mesh.

Methods: We conducted a randomized prospective clinical trial to compare these two surgical approaches. 44 patients have undergone a laparoscopic pectopexy and 41 patients were treated by laparoscopic sacropexy.

Results: The average operating time (43.1 vs. 52.1 min) and blood loss (4.6 vs. 15.3 ml) were significantly lower in the pectopexy group. No major complications occurred in either group. There were no significant differences between the groups with regard to body mass index, hospital stay duration, voiding difficulties, urinary tract infections and C-reactive protein values in the postoperative period. We reevaluated 42 pectopexy and 41 sacropexy patients after 21.8 months (range 12 – 35; pectopexy) and 19.5 months (range 12 – 37; sacropexy). There were one relapse of the apical prolapse in the pectopexy arm and four relapse cases in the sacropexy group. The occurrence of de novo lateral-defect cystocele (0 vs. 5 patients), and constipation (0 vs. 8 patients) were significantly higher in the sacropexy group (p < 0.05).

Conclusion: Pectopexy is a promising method of apical prolapse correction.