Laparoscopic suture pectopexy for advanced stage vaginal vault prolapse: a feasible alternative to synthetic mesh (Biyik’s modification)

Abstract

OBJECTIVES: The aim of the study is to evaluate the safety and feasibility of using a nonabsorbable suture instead of synthetic mesh in laparoscopic pectopexy. MATERIAL AND METHODS: Women diagnosed with symptomatic Pelvic Organ Prolapse Quantification (POP-Q) stage III and IV vaginal vault prolapse were included in this study. A 30-mm needle armed with a 0 polypropylene monofilament suture was used instead of synthetic mesh. Preoperative outcomes, suture-related complications and recurrence were analyzed. Anatomical success was defined according to the POP-Q, patient quality of life was assessed using the Prolapse Quality of Life Questionnaire (P-QOL). RESULTS: A total of 26 women underwent LSP. The median age was 60 years. The median operating time was 61 minutes. The median estimated blood loss was 90 mL. There were no recorded intraoperative complications. The mean pain assessment 24 hours later with VAS score was 2 (range 0-10). The median length of hospital stay was 2 nights (range 1-3 nights). No patient developed recurrence or de novo prolapse in the median follow-up period of 6 months. Neither suture erosion, infection, nor suture sensation by the partner were detected. All variables of POP-Q points significantly improved after surgery (p < 0.05). Significant improvement was observed in each score of the P-QOL, (p = 0.003 for sleep/energy score, p < 0.0001 for all other scores). CONCLUSIONS: Polypropylene suture represents a reliable and feasible alternative to synthetic mesh in laparoscopic pectopexy for vault prolapse. Further multicentric, prospective studies with long-term follow-up are required to integrate this technique into standard practice.