A Randomized Trial of Laparoscopic Sacropexy versus Transvaginal Mesh for High-Grade Apical Pelvic Organ Prolapse

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 193–204

DOI: 10.46882/2026/IJOG/000493

Original Research Article

Title: A Randomized Trial of Laparoscopic Sacropexy versus Transvaginal Mesh for High-Grade Apical Pelvic Organ Prolapse

Names of Authors: Kofi A. Mensah¹

Authors’ Affiliations:
¹ Urogynecology Unit, Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana

Abstract:
The ideal surgical approach for severe apical pelvic organ prolapse remains widely debated due to balance requirements between anatomical durability and complication profiles. This randomized clinical trial compared the 3-year anatomical success rates, functional outcomes, and adverse events of Laparoscopic Sacrocolpopexy/Sacropexy (LSP) versus Transvaginal Mesh (TVM) placement. One hundred and sixty postmenopausal women presenting with symptomatic stage III or IV apical prolapse were randomized into two equal groups (n = 80 per group). The primary outcome was objective anatomical success defined as Pelvic Organ Prolapse Quantification (POP-Q) stage 0 or I at the apical compartment 36 months postoperatively. At the 3-year mark, LSP demonstrated a significantly higher objective anatomical success rate compared to the TVM group (93.8% vs. 81.3%, p = 0.018). Subjective symptom improvement, measured via the Pelvic Floor Distress Inventory (PFDI-20), was high in both cohorts (p < 0.001). However, the TVM group experienced a significantly higher incidence of mesh exposure/erosion into the vaginal epithelium compared to the LSP arm (11.3% vs. 1.3%, p = 0.009), frequently necessitating secondary surgical excision. Dyspareunia rates were also higher after TVM procedures (15.4% vs. 3.8%, p = 0.034). Operative time was shorter in the transvaginal approach (54.2 ± 12.5 minutes vs. 112.6 ± 24.8 minutes, p < 0.001). Laparoscopic sacropexy provides superior long-term structural durability and a lower complication rate for advanced apical pelvic organ prolapse compared to transvaginal mesh, supporting its use as a preferred intervention in eligible surgical candidates.

Keywords: Pelvic Organ Prolapse; Apical Suspension; Laparoscopic Sacrocolpopexy; Transvaginal Mesh; Mesh Erosion; Dyspareunia.

Manuscript Timeline: Received: May 02, 2026; Revised: June 25, 2026; Accepted: July 18, 2026; Published: August 04, 2026.

Citation: Mensah KA. A Randomized Trial of Laparoscopic Sacropexy versus Transvaginal Mesh for High-Grade Apical Pelvic Organ Prolapse. International Journal of Obstetrics and Gynecology. 2026; 14(8): 193–204.

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