Perioperative complications of laparoscopic sacrohysteropexy versus sacrocolpopexy with subtotal hysterectomy for pelvic organ prolapse

Pelvic organ prolapse (POP) affects 23.4% of women in Saudi Arabia. Laparoscopic sacrocolpopexy is the established surgical gold standard; however, whether concomitant hysterectomy confers additional perioperative risk remains debated. This retrospective cohort study included 179 women who underwent laparoscopic sacrocolpopexy with subtotal hysterectomy ( n = 119) or laparoscopic sacrohysteropexy ( n = 60) at two tertiary referral centers in Riyadh, Saudi Arabia, between 2009 and 2024. Intraoperative and postoperative complications, perioperative hemoglobin change, and hospital stay duration were compared between groups. The sacrocolpopexy group was significantly older ( P = 0.004). Organ injury occurred in 0.6% of cases overall. Blood transfusion was required exclusively in the sacrohysteropexy group (3.3% vs. 0.0%, P = 0.045). Both groups demonstrated a statistically significant postoperative hemoglobin decline — sacrocolpopexy: 124.52 ± 15.07 to 110.60 ± 13.77 g/L; sacrohysteropexy: 125.27 ± 13.20 to 110.29 ± 12.18 g/L ( P < 0.001) — with no significant between-group difference ( P = 0.747) and neither decline reaching clinical significance. Sacrohysteropexy was associated with shorter hospitalization (44.6% vs. 24.6% discharged within two postoperative days, P = 0.012). Reoperation rates and symptom resolution were comparable between groups. No significant between-group differences in perioperative morbidity were detected. Sacrohysteropexy was associated with shorter hospital stay; however, the clinical relevance of the higher transfusion rate is uncertain, given the small event count. Given baseline group non-comparability and the retrospective design, these results should be regarded as exploratory. The surgical approach should be individualized based on patient characteristics and the surgeon’s expertise. Prospective randomized trials are warranted.