UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

PECTOPEXY

Hümeyra Akbaş

Mardin Training and Research Hospital, Department of Perinatology, Mardin, Türkiye

Akbaş H. Pectopexy. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.287-296.

ABSTRACT

Pelvic organ prolapse is a prevalent pelvic floor disorder that can cause significant functional and psychosocial impairment in affected women. Among its subtypes, apical prolapse, characterized by the descent of the uterus or vaginal vault, remains a challenging condition for surgeons. Although sacrocolpopexy has long been considered the gold standard for apical suspension, its technical complexity, prolonged operative time, and potential complications—including defecation dysfunction, hemorrhage, and nerve injury—have driven the search for alternative methods.

Pectopexy, first introduced as a laparoscopic technique in 2010, offers suspension of the vaginal apex or uterus to the iliopectineal (Cooper’s) ligaments. This approach preserves the physiological vaginal axis, reduces risks related to presacral dissection, and is technically more feasible in obese patients or those with extensive adhesions. Recent studies have demonstrated comparable anatomical success rates between pectopexy and sacrocolpopexy, while reporting advantages such as shorter operative times, reduced intraoperative blood loss, and lower incidence of de novo constipation.

Both mesh-based and mesh-free variants of pectopexy have been described. While mesh-based techniques achieve high objective success, concerns regarding erosion, infection, and chronic pelvic pain have encouraged development of suture-only methods, such as unilateral pectineal suspension and laparoscopic non-mesh cerclage pectopexy. These alternatives may be particularly beneficial in resource-limited settings. Furthermore, uterus-preserving approaches have gained popularity, as they maintain native pelvic anatomy, minimize blood loss, and improve self-esteem and sexual function. Reports of successful pregnancies following pectopexy strengthen its role in women of reproductive age.

The learning curve of pectopexy, evaluated by cumulative sum analysis, appears shorter and less demanding than that of sacrocolpopexy. Patient-reported outcomes indicate significant improvements in quality of life and sexual function, with high levels of satisfaction. Comparative trials against sacrospinous ligament fixation also suggest more favorable results in terms of sexual function and anterior compartment support.

In conclusion, pectopexy represents an effective, safe, and versatile option for apical prolapse surgery, providing anatomical durability with functional and psychosocial benefits. Its adaptability to laparoscopic and robotic platforms, as well as to mesh-free and uterus-preserving strategies, positions it as a promising alternative to conventional methods.

Keywords: Pectopexy; Pelvic organ prolapse; Apical support; Uterus-preserving surgery; Mesh-free surgery; Laparoscopic surgery; CUSUM curve; Quality of life

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