Despite being the gold standard for apical prolapse correction, sacral colpopexy is associated with prolonged operative time, risks of vascular and nerve damage during access to the presacral region and remarkable surgical expertise. As an alternative technique to laparoscopic sacral colpopexy (LSCP), laparoscopic lateral suspension (LLS) has been gaining in importance in recent years. The aim of the study was to summarize and compare available data between LSCP and LLS according to Dubuisson technique.

PubMed (MEDLINE), Web of Science and Google Scholar were systematically searched from the inception of each database until December 2024. Studies including a comparison of at least one efficacy outcome (objective or subjective success rate) between LSCP and LLS were selected. Surgery-related data and follow-up data were also extracted, where available. Results were pooled using random-effects meta-analysis.

A total of six studies were included counting 632 patients. The meta-analysis did not report statistical differences between LSCP and LLS in terms of objective success 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 minutes, CI 95% (16.75, 69.45); I² = 97%; P = 0.001], however, no major differences were found regarding intraoperative and early post- operative complications. Re-operation and recurrence rates of apical prolapse rate were equivalent between groups (p=0.97 and p=0.79). Follow-up data regarding quality of life showed no significant differences in about de novo stress urinary incontinence, intestinal impairment, sexual function, and pain after surgery.

This meta-analysis found that LLS offers comparable anatomical success rates for anterior and apical prolapse and subjective success rate, while significantly reducing operative time. Although the rate of new onset of posterior prolapse is comparable between the two techniques, the presence of a posterior vaginal prolapse prior to surgery would likely expose the LLS group to higher rates of posterior recurrence. At present, it is not possible to consider these techniques as alternatives, but they should be considered for a specific group of patients. The recurrence rates of apical prolapse are comparable between the two techniques, which is consistent with data in literature. On the other hand, recent literature suggests that laparoscopic sacral colpopexy remains the more effective treatment for recurrent pelvic organ prolapse.

LLS has shown comparable results to LSCP in the treatment of apical and anterior prolapse in selected patients, while reporting a shorter operative time. The lack of long-term follow-up and the paucity of data on patients with advanced apical prolapse do not allow LLS to be declared an alternative but equally effective treatment compared to LSCP.