This study aimed to evaluate the safety and clinical efficacy of a combined laparovaginal pelvic floor reconstruction, involving anterior and posterior colporrhaphy, perineoplasty, and simplified sacrohysteropexy, for treating pelvic organ prolapse (POP).

A single-center retrospective cohort study was conducted involving 74 patients who underwent laparovaginal hybrid pelvic floor reconstruction between July 2021 and July 2023. Inclusion criteria were anterior-apical prolapse (POP-Q stages Ba, C ≥ 0), without prior hysterectomy, malignancies, or active infections. Surgery involved vaginal anterior and posterior colporrhaphy with perineoplasty, followed by laparoscopic sacrohysteropexy, with the implant fixed to the cervix and sacrum (Figures 1 and 2). Outcomes were assessed through POP-Q staging, validated questionnaires (PFDI-20, PISQ-12, ICIQ-SF), and complication rates at 12–18 months postoperatively.

The mean operative time was 162.2±45.2 minutes, with no significant intraoperative or immediate postoperative complications. Anterior colporrhaphy was performed in 68%, posterior colporrhaphy in 78%, and perineoplasty in 68% of patients. At follow-up, POP recurrence requiring reoperation was identified in 4 patients (5%). De novo urinary incontinence occurred in 3 patients (4%), and worsening of pre-existing stress urinary incontinence (SUI) was observed in 2 patients (2.7%), requiring subsequent sling implantation . There were no implant erosions or cases of de novo dyspareunia. Patients reported significant improvement in quality of life across all questionnaire subscales (Figure 3).

The combined laparovaginal approach demonstrated high efficacy and favorable safety outcomes. The low recurrence rate (5%)  indicates effective anatomical correction, particularly considering the simplified fixation technique without extensive vaginal dissection. The absence of implant-related complications such as erosion and dyspareunia highlights the advantages of preserving uterine anatomy and minimizing extensive dissection. The study’s findings suggest the laparovaginal technique effectively addresses both anatomical and functional aspects of pelvic floor defects, significantly enhancing patient-reported outcomes. Moreover, the simplified sacrohysteropexy potentially reduces the risk of severe intraoperative complications (e.g., bowel and bladder injury), observed in 0.4–10% of traditional procedures [1]. Importantly, no intraoperative injuries occurred in our cohort, further supporting the safety of this modified approach. 
Despite these promising findings, the retrospective study design, absence of a control group, and relatively small sample size constitute notable limitations. Larger, prospective comparative studies are necessary to validate these results and refine patient selection criteria further.

The combined laparovaginal hybrid reconstruction is a safe and effective surgical option for comprehensive pelvic floor repair, demonstrating high anatomical and functional success rates and significant improvement in patient quality of life, with a minimal complication rate. Further prospective randomized controlled trials are recommended to establish the procedure’s long-term efficacy and safety profile.

Cosma S, Petruzzelli P, Chiadò Fiorio Tin M, et al. Simplified laparoscopic sacropexy avoiding deep vaginal dissection. Int J Gynaecol Obstet. 2018;143(2):239-245. doi:10.1002/ijgo.12632