Sacrocolpopexy is often regarded as benchmark surgical approach for addressing apical prolapse, but it can be difficult in patients having extensive pelvic adhesions or colonic diverticulosis. Pectopexy serves as an alternative to sacrocolpopexy and may offer potential benefits to patients.

This was a retrospective review of 17 laparoscopic pectopexies and 23 laparoscopic sacrocolpopexies performed from January 2022 to January 2024 at an academic tertiary referral centre. The outcomes from laparoscopic pectopexy were compared with laparoscopic sacrocolpopexy performed at the same institution by the same surgeons. Patients with symptomatic primary vault prolapse POP-Q >1 were considered for this study. Patients with previous operations for vault prolapse correction were excluded from consideration. In pectopexy a Maltese cross pattern mesh is attached to anterior and posterior wall of vagina with arms attached to right and left pectineal ligaments. The primary outcome was recurrent prolapse (stage ll or greater). The Secondary outcomes were rate of urinary retention requiring intervention, rate of mesh related complications, rate of de novo constipation, rate of de novo stress urinary incontinence, overall complication rates as well as average operative time.

Demographic data between both groups were similar with comparable POP-Q prolapse stage. Urinary retention requiring intervention was seen 8.69% of patients who underwent sacrocolpopexy whereas no patients in pectopexy group experienced this complication. There were no mesh related complications in pectopexy group, whereas, 4.34% of the patients in sacrocolpopexy had mesh related complications. De-novo constipation was seen in 21.7% of the patients who underwent sacrocolpopexy and none of the patients who underwent pectopexy had such problems. De-novo stress urinary incontinence was exclusively seen in patients who underwent sacrocolpopexy(8.69%). Recurrent prolapse was seen among 5.88% of patients who underwent pectopexy and 13.04% of patients who underwent sacrocolpopexy at most recent follow-up. The overall complication rate was 5.88% in pectopexy patients and 30.0% in sacrocolpopexy patients. The average operative times were 135 minutes for pectopexy and 162.73 minutes for sacrocolpopexy. The average lengths of follow-up were 12 months and 13.3 months for pectopexy and sacrocolpopexy respectively

Because the pectopexy procedure is carried out entirely in the anterior pelvis, it avoids dissection in the deeper pelvic regions. This also means that dissection of the presacral space is avoided, which helps to minimize the risk of bleeding, minimise injury to hypogastric nerves, less steep Trendelenburg position and placement of the mesh relatively distant from the colon. Even though sacrocolpopexy continues to be the gold standard operation for apical prolapse, according to our data, pectopexy can offer excellent results. Hence, in lieu of these findings, we can confidently counsel our patients regarding pectopexy producing better results to a sacrocolpopexy with less chances of de novo constipation and less overall complication rates.