Lateral suspension vs. sacral colpopexy for treating pelvic organ prolapse: a systematic review and meta-analysis

Purpose: Although sacral colpopexy is considered the gold standard for correcting apical prolapse, it is associated with extended operative times and surgical complications. An alternative surgical approach is currently being investigated. This meta-analysis aims to summarize and compare the available data on laparoscopic sacral colpopexy (LSCP) and laparoscopic lateral suspension (LLS) as per the Dubuisson technique. Methods: A systematic search of PubMed (MEDLINE) and Google Scholar was conducted from the inception of each database until December 2024. Studies comparing LSCP and LLS on at least one efficacy outcome selected. Objective or subjective success rate, surgery-related data and follow-up data were extracted. Results were pooled using a random-effect meta-analysis. Results: A total of 6 studies were included. The meta-analysis did not report statistical differences between LSCP and LLS in terms of apical prolapse [OR = 1.24; CI 95% (0.61, 2.52); I2 = 0%; P = 0.55] and anterior prolapse [OR = 0.78; CI 95% (0.45, 1.37); I2 = 0%; P = 0.39] correction. Subjective success rate was similar (P = 0.72). LLS required shorter operative time [43.1 min, CI 95% (16.75, 69.45); I2 = 97%; P = 0.001]. No major differences were found regarding intraoperative and early post-operative complications, re-operation and recurrence rates. Follow-up data regarding quality of life showed no significant differences about de novo stress urinary incontinence, intestinal impairment, sexual function, and pain after surgery. Conclusions: LLS provides similar outcomes to LSCP for apical and anterior prolapse in selected cases. However, limited long-term data and few studies on advanced prolapse prevent LLS from being declared an equally effective alternative at this time. PROSPERO registration number: CRD42024537270.