Comparative Effectiveness of Laparoscopic Lateral Suspension, Pectopexy and Sacrocolpopexy for Apical Pelvic Organ Prolapse: A Propensity-Weighted Retrospective Cohort Study.

INTRODUCTION AND HYPOTHESIS: The objective was to compare anatomical and safety outcomes of laparoscopic lateral suspension (LS), pectopexy (PP), and sacrocolpopexy (SCP) for apical pelvic organ prolapse (POP) in a retrospective comparative cohort using propensity score weighting. The cohort consisted of consecutive women undergoing LS, PP or SCP at a tertiary referral centre between 2017 and 2023. METHODS: Confounding by indication was addressed using a multinomial propensity score with inverse probability of treatment weighting; covariate balance was assessed by standardised mean differences. Weighted regression models with robust standard errors were used; primary-outcome pairwise comparisons were Holm corrected. Sensitivity analyses included overlap weighting, entropy balancing and doubly-robust estimation. The main outcome measures were 12-month apical anatomical success; perioperative outcomes; Clavien-Dindo complications; mesh-related events; reoperation; time to recurrence. RESULTS: Of 188 women (58 with SCP, 63 with PP, 67 with LS), 12-month apical success was 74.1%, 73.0%, 80.6%, with no significant pairwise differences (PP vs SCP: aOR 0.80, 95% CI 0.33-1.93; LS vs SCP: aOR 1.42, 95% CI 0.56-3.60; global p = 0.437). Post hoc analysis indicated 80% power only for large effects (≈18 percentage points). LS required longer operative time (+44.2 min, p < 0.001); PP had modestly higher blood loss (+23.6 ml, p = 0.038). Complications, mesh exposure, reoperation and time-to-recurrence did not differ. Findings were robust across sensitivity analyses. CONCLUSIONS: No significant differences in 12-month apical success or safety were detected among women undergoing SCP, PP or LS after adjustment; LS required a longer operative time. Wide confidence intervals and absence of a prespecified non-inferiority margin preclude any equivalence claim; short-term findings cannot be extrapolated to long-term durability.