We aim to assess the long-term outcomes of our novel hysteropexy procedure- Laparoscopic Long Mesh Surgery (LLMS) with augmented round ligaments.

Sixty-six consecutive women with main uterine prolapse stage II or greater defined by the Pelvic Organ Prolapse (POP) quantification staging system were referred for Laparoscopic Long Mesh Surgery ( LLMS). Long mesh is a synthetic T-shaped mesh, with the body fixed at the uterine cervix and the two arms fixed along bilateral round ligaments till 4 cm above ASIS (anterior superior ischial spine). Clinical evaluations before and 6 months after surgery included pelvic examination, one -hour pad test ,multichannel urodynamic study, and questionnaires for urinary and sexual symptoms.

After a follow-up time of at least 60 months, the overall anatomical success rate was 84.9% (56/66). The average operative time was 58.4 ± 26.8 minutes. No major complications were recognized during or after surgery. The lower urinary tract symptoms and scores on questionnaires improved significantly after the surgery, except urgency urinary incontinence and nocturia. Neither voiding nor storage dysfunction was recognized after the operations. All of the domains and total Female Sexual Function Index (FSFI) scores of the 28 sexually-active women did not differ significantly after  Laparoscopic Long Mesh Surgery (LLMS).

Laparoscopic long mesh surgery (LLMS) with augmented round ligaments provides durable anatomical correction of apical prolapse with favorable safety and functional outcomes. While it significantly improves most lower urinary tract symptoms, urgency-related symptoms remain unchanged, highlighting the need for adjunctive management of overactive bladder. The procedure appears to preserve sexual function and offers a time-efficient alternative to traditional reconstructive techniques.

The results of our study suggest that Laparoscopic long mesh surgery (LLMS) is an effective, safe, and time-saving pelvic reconstructive surgery for the treatment of apical prolapse which has good surgical efficiency and causing less vaginal dyspareunia and preserves sexual function.