Application of the Dual-Axis Theory in the Management of Multicompartment Pelvic Organ Prolapse: Experience from Eight Cases

Background & Objective: Pelvic organ stability is maintained by two principal axes: the anterior perineal suspension axis (APSA) and the posterior perineal suspension axis (PPSA). Concomitant impairment of both axes results in multicompartment pelvic organ prolapse (MC‑POP), a complex condition that significantly affects quality of life. The laparoscopic dual‑axis fixation (LADAF) technique was developed to restore both axes simultaneously, aiming to provide a physiological and comprehensive reconstruction of the pelvic floor. To evaluate the early outcomes of LADAF in the treatment of MC-POP. Materials & Methods: A retrospective descriptive case series was conducted on patients with MC-POP who underwent LADAF at Hanoi Medical University Hospital between January 2020 and June 2025. Results: The mean operative time was 132.5 minutes, and the average hospital stay was 4.11 days. One intraoperative complication, involving a tear of the rectal muscularis–serosal layer, was recorded. Postoperative complications included one case of urinary retention and one case of constipation, both of which resolved with conservative treatment. A marked improvement was observed in prolapse severity across all three pelvic compartments. The mean Pelvic Floor Distress Inventory-20 (PFDI-20) score decreased from 171.66 to 12.89, and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) score decreased from 152.5 to 25.55. No recurrence was noted during a mean follow-up of 27.5 months. Conclusion: LADAF is a safe and effective laparoscopic approach for MC-POP, providing physiological restoration of pelvic support structures and significant improvement in quality of life. Further studies with larger sample sizes and longer follow-up are required to confirm its long-term durability.