Mid-Term Outcomes of Posterior Pelvic Reconstruction Combined with Lateral Abdominal Wall Suspension versus Sacrocolpopexy for Advanced Pelvic Organ Prolapse: A Retrospective Comparative Study

Purpose: To compare mid-term efficacy, safety, and functional outcomes of laparoscopic sacrocolpopexy (LSC) versus laparoscopic lateral abdominal wall suspension (LAWS), both combined with standardized posterior repair, for advanced multi-compartment pelvic organ prolapse (POP). Patients and Methods: Retrospective analysis of 132 patients with POP-Q stage ≥III apical defects and concomitant anterior/posterior prolapse (2019– 2021). Seventy underwent LSC + posterior repair (control), 62 underwent LAWS + posterior repair (observation). Perioperative outcomes, anatomical restoration (POP-Q), patient-reported outcomes (PFDI-20, PFIQ-7, PISQ-12), and 3-year complications were compared. Results: LAWS showed shorter operative time (136.08± 17.48 vs 174.81± 27.36 min, P < 0.001), less blood loss (27.92± 12.91 vs 54.64± 27.78 mL, P < 0.001), and lower surgical failure rate (0% vs 4.3%, P < 0.05). LSC failures included one conversion to laparotomy (presacral hemorrhage) and two conversions to LAWS (severe adhesions/anomalous promontory). Both groups achieved comparable anatomical restoration at 3 months and significant quality-of-life improvements at 6 months (all P < 0.05). At 3 years, de novo stress urinary incontinence, apical recurrence, and mesh exposure did not differ between groups. Defecatory dysfunction was significantly lower with LAWS (3.2% vs 14.3%, P < 0.05). Conclusion: Both LSC and LAWS with posterior repair are effective for advanced POP. LAWS offers advantages in operative safety, recovery, and lower risk of defecatory dysfunction, positioning it as a viable alternative. Treatment choice should be individualized based on patient anatomy and surgeon expertise. Keywords: pelvic organ prolapse, laparoscopic lateral suspension, laparoscopic sacrocolpopexy, pelvic floor reconstruction, treatment outcome, postoperative complications