Laparoscopic Anterior Perineal Suspension Using Bilateral Pectineal Ligament Fixation for Pelvic Organ Prolapse

Abstract

Background:

Pelvic organ prolapse (POP) impairs quality of life. When conservative measures fail, surgery is indicated. We evaluated laparoscopic anterior perineal suspension with bilateral pectineal ligament fixation (LAPSPL), which reconstructs the anterior suspension axis to support the bladder and uterus.

Methods:

A single-center retrospective cohort of women with stage III–IV POP who underwent LAPSPL at Hanoi Medical University Hospital (May 2022–March 2025) was included. A mesh shaped to mimic the pubocervical fascia was fixed to the anterior cervico-vaginal wall; lateral arms were anchored to the bilateral pectineal (Cooper’s) ligaments. Primary outcomes were anatomical correction (Baden–Walker stage; cystocele grade). Secondary outcomes included operative metrics, complications, pelvic floor symptoms (Pelvic Floor Distress Inventory [PFDI]-20), quality of life (Pelvic Floor Impact Questionnaire [PFIQ]-7), and recurrence.

Results:

Ninety-three patients (mean age 66.4 years; parity 3.5; BMI 21.6) were included. Preoperatively, 41.9% had stage III and 58.1% stage IV POP. Postoperatively, stages 0, I, II, and III were 44.1%, 48.4%, 4.3%, and 3.2%, respectively; no stage IV. Cystocele improved from 57.0% grade III/2.2% grade IV to 1.1% grade III/0% grade IV. Mean operative time was 90.7 minutes. One intraoperative bladder seromuscular injury occurred (1.1%). Postoperative events were urinary dysfunction 4.3%, bowel dysfunction 2.2%, and chronic pain 3.2%; no mesh rejection. PFDI-20 and PFIQ-7 declined to 16.4 and 14.2, respectively, at 6 months. Over 14.4 months’ mean follow-up, recurrence was 3.2%.

Conclusions:

LAPSPL is a safe, minimally invasive option for advanced POP that achieves anatomical restoration, symptom relief, and quality-of-life gains with low complications and early recurrence. Comparative studies with longer follow-up are needed.