Surgical Outcomes and Recurrence‐Free Survival After Laparoscopic Sacrocolpopexy, Laparoscopic Colposuspension Sec Shull, and Vaginal Colpohysterectomy and Colposuspension: A Retrospective Analysis

OBJECTIVES: To compare surgical outcomes and recurrence-free survival (RFS) among laparoscopic sacrocolpopexy (LSC), laparoscopic colposuspension sec Shull (LCSS), and vaginal colpohysterectomy and colposuspension (VCH) for pelvic organ prolapse involving the apical compartment. METHODS: This retrospective observational study included patients undergoing surgery for pelvic organ prolapse involving the apical compartment. Patients were divided into three groups according to surgical technique: LSC, LCSS, and VCH. The primary outcome was prolapse recurrence. Secondary outcomes included operative time, postoperative complications, and reoperation rate. RFS was analyzed using Kaplan-Meier curves and Cox proportional hazards models, with LSC as the reference. A predefined subanalysis was performed in patients with severe pelvic organ prolapse (Stage III-IV). RESULTS: A total of 204 patients were included. Median follow-up was 25 months (IQR 16-43) after LSC, 24 months (IQR 15-29) after LCSS, and 31 months (IQR 29-48.25) after VCH. Twenty recurrences occurred: five after LSC, nine after LCSS, and six after VCH. Operative time differed significantly among techniques, while postoperative complication rates were comparable. Kaplan-Meier analysis showed worse RFS after LCSS. In Cox analysis, LCSS was associated with a higher recurrence hazard than LSC (HR 17.20, 95% CI 3.67-80.57; p < 0.001), whereas VCH was not (HR 0.86, 95% CI 0.26-2.85; p = 0.80). Concomitant anti-incontinence procedures were performed in only five patients and were not associated with recurrence or reoperation (both Fisher's exact p = 1.00). CONCLUSIONS: LCSS showed significantly worse RFS than LSC, despite similar complication rates and intermediate operative times. These findings may suggest reduced short- to mid-term RFS; however, they should be interpreted with caution given the retrospective, non-randomized design and potential treatment allocation bias. VCH showed the shortest operative times and no significant differences in recurrence risk compared with LSC.