A Novel Approach for Apical Prolapse Surgery: Meshless Pectopexy (Salman's Modification).

Abstract

Introduction and hypothesis: This video demonstrates the laparoscopic meshless pectopexy with uterine preservation (Salman's modification).

Methods: This study in a single group semi-experimental design was carried out in a secondary center. From May 2022 to April 2024, a total of 40 consecutive symptomatic women with stage 3-4 apical prolapse requesting uterine protection were included in the study. Without using mesh, patients received a laparoscopic pectopexy using monofilament non-absorbable sutures and preserving the uterus. Pelvic organ prolapses quantitative stage 2 or higher, especially in the central compartment (C ≥-1), and anatomical recurrences of genital prolapse were recorded.

Results: In the 1st postoperative year, patients showed a significant improvement in the Pelvic Organ Prolapse Quantification central compartment (C score: mean difference -8.21 ± 3.03, 99% confidence interval -9.20 to -7.21) and in all other landmarks (p < 0.001). Apical prolapse recurrence occurred in 7.9% of cases and stage 3Bp prolapse developed in one patient during the follow-up period. Sexual function and urinary symptom scores (PISQ-12) were significantly improved after surgery.

Conclusions: Laparoscopic meshless pectopexy represents an effective and feasible option for the surgical treatment of uterovaginal prolapse, preserving the uterus and preventing postoperative complications associated with mesh use.