Comparative Outcomes of Uterus-Preserving and Hysterectomy Approaches in Laparoscopic Lateral Suspension

Abstract

Introduction and hypothesis: The objective was to compare the anatomical and functional outcomes of laparoscopic lateral suspension (LLS) with and without concomitant hysterectomy in the treatment of pelvic organ prolapse, in order to guide patient-centered surgical planning. Methods: This retrospective cohort study included 87 patients who underwent LLS between 2021 and 2024. Patients were divided into two groups: LLS with concomitant total laparoscopic hysterectomy (n = 43), and uterus-preserving LLS (n = 44). Surgical parameters, Pelvic Organ Prolapse Quantification (POP-Q) scores, complication rates, recurrence, pelvic pain, and urinary incontinence outcomes were compared over a minimum of 12 months' follow-up. Results: Both groups achieved significant improvements in all POP-Q points (p < 0.0001), with no statistically significant difference in anatomical success, recurrence, pelvic pain, or urinary incontinence. Operative time, blood loss, and hospital stay were significantly higher in the hysterectomy group (p < 0.0001). Vaginal length was better preserved in uterus-preserving procedures. No major intra- or postoperative complications were reported. Conclusions: Concomitant hysterectomy during LLS increases surgical burden without offering clear anatomical or functional advantages. Uterus-preserving LLS is a safe and effective option and may be preferred in appropriately selected patients through shared decision making.