Surgical Outcomes and Recurrence‐Free Survival After Laparoscopic Sacrocolpopexy, Laparoscopic Colposuspension Sec Shull, and Vaginal Colpohysterectomy and Colposuspension: A Retrospective Analysis
P. Romeo, C. Ronsini, A. Tassone, Valeria Palmara, M. Alessandro, G. Vizzielli, S. Restaino, Vittorio Palmara, V. Chiantera, M. Torella, S. CianciABSTRACT
Objectives
To compare surgical outcomes and recurrence‐free survival (RFS) among laparoscopic sacrocolpopexy (LSC), laparoscopic colposuspension sec Shull (LCSS), and vaginal colpohysterectomy and colposuspension (VCH) for pelvic organ prolapse involving the apical compartment.
Methods
This retrospective observational study included patients undergoing surgery for pelvic organ prolapse involving the apical compartment. Patients were divided into three groups according to surgical technique: LSC, LCSS, and VCH. The primary outcome was prolapse recurrence. Secondary outcomes included operative time, postoperative complications, and reoperation rate. RFS was analyzed using Kaplan–Meier curves and Cox proportional hazards models, with LSC as the reference. A predefined subanalysis was performed in patients with severe pelvic organ prolapse (Stage III–IV).
Results
A total of 204 patients were included. Median follow‐up was 25 months (IQR 16–43) after LSC, 24 months (IQR 15–29) after LCSS, and 31 months (IQR 29–48.25) after VCH. Twenty recurrences occurred: five after LSC, nine after LCSS, and six after VCH. Operative time differed significantly among techniques, while postoperative complication rates were comparable. Kaplan–Meier analysis showed worse RFS after LCSS. In Cox analysis, LCSS was associated with a higher recurrence hazard than LSC (HR 17.20, 95% CI 3.67–80.57; p < 0.001), whereas VCH was not (HR 0.86, 95% CI 0.26–2.85; p = 0.80). Concomitant anti‐incontinence procedures were performed in only five patients and were not associated with recurrence or reoperation (both Fisher's exact p = 1.00).
Conclusions
LCSS showed significantly worse RFS than LSC, despite similar complication rates and intermediate operative times. These findings may suggest reduced short‐ to mid‐term RFS; however, they should be interpreted with caution given the retrospective, non‐randomized design and potential treatment allocation bias. VCH showed the shortest operative times and no significant differences in recurrence risk compared with LSC.