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Background <p>Laparoscopic lateral suspension (LLS) is an effective mesh-based repair for pelvic organ prolapse (POP), but the optimal concomitant hysterectomy strategy — total (TH) versus subtotal (STH) — remains undefined. We compared anatomic outcomes, patient-reported outcomes, and complication profiles of LLS combined with TH (LLSHR) versus LLS combined with STH (LLSHE) in a prospective cohort of women who made an informed choice between the two procedures.</p> Methods <p>In this prospective comparative study conducted at Chengdu Integrated TCM &amp; Western Medicine Hospital between October 2021 and October 2024, 82 women with symptomatic POP-Q stage II or III uterovaginal prolapse were counseled regarding both hysterectomy options and self-selected into the LLSHR group (<i>n</i> = 41) or the LLSHE group (<i>n</i> = 41). The study was approved by the institutional review board (IRB 2021.XJS.019) and retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2600118158). Primary outcomes were POP-Q point C and PISQ-12 score at 12 months. Secondary outcomes included POP-Q points Ba and Bp, PFDI-20, PFIQ-7, operative parameters, and mesh-related complications through 24 months.</p> Results <p>All 82 participants completed surgery as planned. At 12 months, point C was significantly more negative in the LLSHE group than in the LLSHR group (− 5.1 ± 0.5&#xa0;cm vs. −4.5 ± 0.6&#xa0;cm; <i>P</i> &lt; 0.001), indicating superior apical support with cervical preservation. The PISQ-12 score at 12 months was significantly higher (better) in the LLSHE group (37.5 [IQR 33.0–42.5] vs. 31.0 [27.0–34.0]; <i>P</i> &lt; 0.001). PFDI-20 and PFIQ-7 improved substantially in both groups with no between-group difference at any time point (all <i>P</i> &gt; 0.05). At 24 months, point C remained significantly more negative in the LLSHE group (− 4.8 ± 0.5 vs. −4.4 ± 0.6; <i>P</i> = 0.004), and the PISQ-12 advantage of LLSHE persisted (37.0 [34.0–43.0] vs. 31.5 [26.8–39.0]; <i>P</i> = 0.005). Mesh exposure was observed in 3 patients (9.4%) in the LLSHR group and none in the LLSHE group (<i>P</i> = 0.226). Operative time was significantly shorter in the LLSHE group (149.0 [143.0–165.0] min vs. 171.0 [150.0–186.0] min; <i>P</i> = 0.002).</p> Conclusions <p>In women undergoing LLS for POP, STH was associated with superior apical support and better sexual function at both 12 and 24 months, with shorter operative time and a numerically lower rate of mesh exposure compared with TH. Given the non-randomized design, these findings should be interpreted as hypothesis-generating. Prospective randomized trials are warranted to confirm these associations. Trial registration: ChiCTR2600118158; registered February 2, 2026, retrospectively registered.</p>

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Single-port laparoscopic lateral suspension with total versus subtotal hysterectomy for pelvic organ prolapse: a prospective comparative study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月2日

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  • Hong-Mei Wu,
  • Ning Xu,
  • Yuan-Hong Li,
  • Zhi-Gui Luo,
  • Rui Xiong,
  • Min Li,
  • Meng-Xi Li

摘要

Background

Laparoscopic lateral suspension (LLS) is an effective mesh-based repair for pelvic organ prolapse (POP), but the optimal concomitant hysterectomy strategy — total (TH) versus subtotal (STH) — remains undefined. We compared anatomic outcomes, patient-reported outcomes, and complication profiles of LLS combined with TH (LLSHR) versus LLS combined with STH (LLSHE) in a prospective cohort of women who made an informed choice between the two procedures.

Methods

In this prospective comparative study conducted at Chengdu Integrated TCM & Western Medicine Hospital between October 2021 and October 2024, 82 women with symptomatic POP-Q stage II or III uterovaginal prolapse were counseled regarding both hysterectomy options and self-selected into the LLSHR group (n = 41) or the LLSHE group (n = 41). The study was approved by the institutional review board (IRB 2021.XJS.019) and retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2600118158). Primary outcomes were POP-Q point C and PISQ-12 score at 12 months. Secondary outcomes included POP-Q points Ba and Bp, PFDI-20, PFIQ-7, operative parameters, and mesh-related complications through 24 months.

Results

All 82 participants completed surgery as planned. At 12 months, point C was significantly more negative in the LLSHE group than in the LLSHR group (− 5.1 ± 0.5 cm vs. −4.5 ± 0.6 cm; P < 0.001), indicating superior apical support with cervical preservation. The PISQ-12 score at 12 months was significantly higher (better) in the LLSHE group (37.5 [IQR 33.0–42.5] vs. 31.0 [27.0–34.0]; P < 0.001). PFDI-20 and PFIQ-7 improved substantially in both groups with no between-group difference at any time point (all P > 0.05). At 24 months, point C remained significantly more negative in the LLSHE group (− 4.8 ± 0.5 vs. −4.4 ± 0.6; P = 0.004), and the PISQ-12 advantage of LLSHE persisted (37.0 [34.0–43.0] vs. 31.5 [26.8–39.0]; P = 0.005). Mesh exposure was observed in 3 patients (9.4%) in the LLSHR group and none in the LLSHE group (P = 0.226). Operative time was significantly shorter in the LLSHE group (149.0 [143.0–165.0] min vs. 171.0 [150.0–186.0] min; P = 0.002).

Conclusions

In women undergoing LLS for POP, STH was associated with superior apical support and better sexual function at both 12 and 24 months, with shorter operative time and a numerically lower rate of mesh exposure compared with TH. Given the non-randomized design, these findings should be interpreted as hypothesis-generating. Prospective randomized trials are warranted to confirm these associations. Trial registration: ChiCTR2600118158; registered February 2, 2026, retrospectively registered.