Comparative Outcomes of Mesh‐Based and Mesh‐Free Laparoscopic Uterus‐Preserving Pectopexy for Apical Prolapse: A Retrospective Cohort Study

Aim To compare the anatomical and functional outcomes of mesh‐based and mesh‐free laparoscopic uterus‐preserving pectopexy in patients with apical pelvic organ prolapse: Methods This retrospective cohort study included 81 patients who underwent either mesh‐based ( n = 41) or mesh‐free ( n = 40) laparoscopic pectopexy between 2021 and 2024. Patients were evaluated for operative time, estimated blood loss, hospital stay, anatomical success based on the POP‐Q system, sexual function using the PISQ‐12 questionnaire, and postoperative complications. Follow‐up assessments were conducted at 6 weeks and 1 year for anatomical outcomes (POP‐Q) and at 3 months and 1 year for sexual function (PISQ‐12). Results Both techniques significantly improved POP‐Q parameters and PISQ‐12 scores. The mesh group demonstrated superior apical and posterior support (C, Ap, and Bp points), while the mesh‐free group showed longer total vaginal length. Operative time was significantly longer in the mesh‐free group. Sexual function improved in both groups, with a greater early improvement in the mesh group, though differences leveled at 1 year. Complication and recurrence rates were low and comparable between groups. Conclusions Mesh‐based and mesh‐free pectopexy both offer effective anatomical correction and functional recovery in apical prolapse surgery. Mesh‐based techniques provide stronger apical support, while mesh‐free approaches may be preferable for patients avoiding synthetic implants. Individualized surgical planning remains essential.