Surgical Options for Apical Prolapse: Comparing Trans-Vaginal and Trans-Abdominal Approaches

Sakineh HajebrahimiIran Speaker Surgical Options for Apical Prolapse: Comparing Trans-Vaginal and Trans-Abdominal Approaches Surgical Options for Apical Prolapse: Comparing Transvaginal and Transabdominal Approaches Background Apical prolapse represents a significant subset of pelvic organ prolapse cases and can profoundly impact quality of life. Surgical correction remains the cornerstone of management, with both transvaginal and transabdominal approaches offering distinct advantages and limitations. The optimal surgical pathway continues to be debated among pelvic floor surgeons. Objective To critically compare transvaginal and transabdominal surgical approaches for apical prolapse, focusing on anatomical and functional outcomes, complication profiles, and long-term durability. Methods A comprehensive review of current literature, including randomized controlled trials, prospective cohort studies, and meta-analyses, was performed. Surgical techniques assessed included vaginal sacrospinous ligament fixation, uterosacral ligament suspension, and transabdominal sacrocolpopexy (open, laparoscopic, and robotic-assisted). Outcome measures included anatomical success rates, recurrence rates, functional urinary and sexual outcomes, operative morbidity, and patient-reported quality of life. Results Transabdominal sacrocolpopexy demonstrates superior long-term anatomical durability and lower recurrence rates, particularly for advanced prolapse, but is associated with longer operative time and higher perioperative morbidity. Transvaginal approaches offer shorter recovery times, lower immediate postoperative complications, and feasibility in high-risk surgical candidates, but may have higher rates of recurrent prolapse over extended follow-up. Minimally invasive abdominal approaches, especially robotic-assisted techniques, may bridge the gap between durability and reduced morbidity. Conclusion Choice of surgical approach for apical prolapse should be individualized, balancing patient-specific anatomical, functional, and comorbidity profiles against surgeon expertise and available resources. Ongoing high-quality comparative studies are essential to refine patient selection criteria and optimize long-term outcomes. Keywords Apical prolapse, sacrocolpopexy, sacrospinous fixation, transvaginal surgery, pelvic floor reconstruction, robotic surgery