Pregnancy Results After Laparoscopic Lateral Suspension Surgery

Pregnancy Results After Laparoscopic Lateral Suspension Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pregnancy Results After Laparoscopic Lateral Suspension Surgery Emin Erhan DONMEZ, Erkan ELCI This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7057434/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : This case series aims to investigate pregnancy results and pelvic organ prolapse (POP) recurrence after uterus-sparing laparoscopic lateral suspension (LLS) in fertility-seeking prolapse patients. Methods : This is a single-center retrospective patient data review study. Between 2019 and 2022, 125 patients underwent LLS, and 20 of 73 patients of reproductive age underwent simultaneous bilateral tubal ligation (BTL). Pregnancy occurred in 11 of the remaining 53 patients, and the data of these women were analyzed. Data were obtained from the medical records of patients who underwent LLS and became pregnant after surgery. Results : A total of eleven women experienced a postoperative pregnancy, with one resulting in spontaneous abortion. Ten women proceeded with their pregnancies, and two resulted in premature delivery. All other babies exhibited a weight commensurate with their gestational age. The patients were offered an elective cesarean section in order to preserve the anatomical results of prolapse surgery. All deliveries were conducted via cesarean section, and no intraoperative complications were encountered during the incisions. The evaluations conducted at the three- and six-month follow-up visits following LLS were documented. One patient exhibited a recurrence of apical prolapse. Conclusion : Patients with future fertility and symptomatic advanced pelvic organ prolapse (POP) represent an appropriate cohort for laparoscopic lateral suspension (LLS). The results of our study demonstrate the feasibility of LLS as an effective surgical technique. This procedure can be employed to treat patients with symptomatic pelvic organ prolapse while preserving fertility in young women. Laparoscopic lateral suspension POP LLS pregnancy Figures Figure 1 Figure 2 Background Pelvic organ prolapse (POP) is a prevalent condition affecting a significant proportion of women throughout their lifespan, with a notable surge in prevalence, particularly following vaginal delivery[1, 2]. Pelvic organ prolapse (POP) is defined by the displacement of pelvic organs (e.g., the uterus, bladder, or bowel) into the vagina due to loss of anatomical support. Patients often express this as a palpable swelling. Such consequences may include adverse effects on sexual function and impaired bladder and bowel function. The lifetime risk of undergoing surgical intervention for POP is estimated to be between 9% and 11%, with projections indicating an anticipated increase in prevalence due to the aging population[3]. The management of POP encompasses a range of options, including conservative approaches, mechanical methods, and surgical interventions, which are selected based on the degree of prolapse and associated symptoms[4]. The objective of surgical intervention is to reinstate the normal anatomy of the vagina, enhance bladder and bowel function, and safeguard sexual function[4, 5]. Vaginal hysterectomy is typically the preferred treatment method, but this approach is now less favored due to high recurrence rates and the desire to preserve fertility in young patients with fertility intentions. In contrast, techniques that spare the uterus, such as sacrohysteropexy, have gained popularity[6]. This technique entails the suspension of the uterus to the sacral promontory via the use of a synthetic mesh. It can be performed through a variety of methods, including laparotomy, laparoscopy, or robotic surgery. It is currently regarded as the gold standard in the surgical treatment of apical prolapse[7]. In recent years, surgical techniques such as lateral suspension and pectopexy have also been employed in the treatment of pelvic organ prolapse (POP). The application of laparoscopic minimally invasive surgeries in the treatment of pelvic organ prolapse (POP) offers several advantages, including reduced blood loss, enhanced anatomical visualization, and a shorter recovery period[7]. Nevertheless, there is limited data in the literature with regard to the outcomes of pregnancy and delivery following such surgical procedures. Some studies have indicated that surgical techniques utilizing mesh may be a relative contraindication for future fertility[8]. Furthermore, the prevalence of older pregnancies among women has increased, resulting in a concomitant rise in the number of women becoming pregnant after pelvic floor reconstructive surgery (POPS). The impact of pregnancy and delivery mode on the recurrence of pelvic floor dysfunction and symptoms following surgery represents a significant area of concern[9]. The extant literature on this topic comprises case reports and series focusing on stress urinary incontinence surgery, and comprehensive data are lacking. The lack of robust evidence renders it challenging to ascertain the optimal mode of delivery for women with a history of postpartum ovarian syndrome (POPS). A survey conducted by the American Urogynecological Society (AUGS) revealed that 40% of obstetricians and gynecologists consistently opt for a cesarean section (CS) in such instances. This is attributable to uncertainty regarding the safety of vaginal delivery. In conclusion, POP is a prevalent condition that has been linked to adverse effects on women's health and quality of life. Advances in surgical techniques, particularly minimally invasive methods, have enhanced outcomes; however, the impact of postoperative pregnancies on these repairs remains poorly understood[9]. In this case series, the management and complications of pregnancies following LLS performed as POP surgery were evaluated in the context of the existing literature. Methods All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the Helsinki Declaration of 1975, as revised in 2000. This study is a retrospective analysis of 11 cases and all data were collected from existing medical records and were anonymized to ensure patient confidentiality, in accordance with institutional and national ethical guidelines. Written informed consent was obtained from the patient or the patient’s legal guardians for the publication of these cases and any accompanying images. All LLS operations for patients who became pregnant were performed by a surgeon with 15 years of experience using the same method (E. ELCI). At the first visit and at each outpatient postoperative follow-up visit, the degree of prolapse was objectively assessed with maximum valsalva by the senior author (E.E.). The International Continence Society Pelvic Organ Prolapse Quantification System (POP-Q) was used for prolapse staging[10]. This was a retrospective cohort study. Electronic data from 125 patients who underwent laparoscopic lateral suspension between 2020-2022 were collected. Seventy-three patients were of reproductive age and did not undergo tubal ligation or salpingectomy; 11 of these patients became pregnant after LLS. In these 11 cases, informed consent (which was obtained from the patient or her legal guardian) was collected for this study. The age of the cases (years), body mass index (BMI) (kg/m²), time between operation and pregnancy (months), last birth (NVD, C/S), and before operation and after birth stage uterine prolapse according to the pelvic organ prolapse quantification (POP-Q) system results were collected. In addition to this, preoperative suspected diagnoses, surgical techniques, postoperative diagnosis, treatment, and surgical photos, if any, were collected. The data were collected, and in data analysis, the mean and standard deviation were calculated for continuous variables. Surgical Analysis The surgical procedure was performed following the steps described in previous publications[11]. Step 1 : Anterior dissection of the vesicovaginal space is performed endoscopically (Fig.1a) to the most distal point possible (Fig.1b). Step 2: A T- or V-shaped Polypropylene Mesh (Mesh, Ethicon, Johnson & Johnson) consisting of a rectangular center (approx. 4 - 6 cm) and two long side arms (approx. 2*18 cm) is placed into the abdomen (Fig.1c). Step 3 : The mesh is fixed to the dissected area from the center with the help of Taker or suture (Fig.1d). Step 4 : A 3 mm skin incision is made 2 cm above the iliac crest and 4 cm behind the anterior superior iliac spine (ASIS) on both sides to create retroperitoneal canals (Fig.1e). Step 5 : Mesh arms are pulled from the created retroperitoneal canal and left free and tension is provided with retroperitoneal fibrosis (Fig.1f). The anatomical localization of the mesh during pregnancy is shown by magnetic resonance imaging (MRI) (Fig.2a) and ultrasonography (Fig.2b), while its appearance during cesarean section is shown in (Fig.2c). Results The demographic and pregnancy outcome data of eleven patients are presented in Table 1. Of the 11 patients who became pregnant, only one resulted in a spontaneous abortion, and two patients experienced preterm labor. All deliveries were conducted via cesarean section. Table 2 presents a summary of the data pertaining to pelvic organ prolapse in patients prior to prolapse surgery and following delivery. The patients were observed at three- and six-month intervals following delivery, and only one case (9%) demonstrated evidence of recurrence. All patients underwent cesarean section in order to reduce the risk of recurrence. No difficulties or complications were encountered during the cesarean section. Discussion In our case study, 125 patients underwent LLS, and 53 of them did not undergo tubal ligation. Postoperative pregnancy occurred in 11 of these patients. Only one patient had a spontaneous miscarriage, and two had preterm labor. Recurrence was observed in only one patient (9%) at three- and six-month follow-up. The majority of studies on pregnancy following POP surgery are case-based. In the most comprehensive of these studies, 46 patients underwent open or laparoscopic sacrohysteropexy[12], 19 patients underwent anterior abdominal wall cervicopexy[13], and 11 patients underwent laparoscopic single mesh sacrohysteropexy[14]. The surgical procedure of sacrohysteropexy has been primarily focused on patients with uterine prolapse who also have a desire to become pregnant. In the context of existing literature, our study represents the inaugural investigation into pregnancy outcomes following LLS in 11 cases. Regarding delivery methods after POP surgery, although there is no general rule, expert opinions are in favor of cesarean section. Cavkaytar et al . reported that cesarean section was a safe and satisfactory method in women who underwent transvaginal sacrospinous hysteropexy (n=8) [15]. Kovac et al . preferred vaginal delivery in women undergoing the same surgery (n=5) [16]. With the rationale of preventing disruption of reconstructed pelvic support, the current literature generally indicates cesarean section as the preferred mode of delivery [17]. Since there is no consensus in the literature on the mode of delivery, we recommended the cesarean section in all cases in our study. In sacrocolpopexy cases, which are more frequently reported in the literature, serious complications have been observed, including pain, discomfort, and, in some instances, erosion of the vaginal wall due to adhesion formation and intestinal obstruction caused by alloplastic materials [18, 19]. The use of mesh in the operation, particularly when wrapped around the isthmus, may theoretically result in compression of the uterine arteries, potentially leading to a disruption in uterine blood supply, which is essential for uterine growth and fetal development. Additionally, sacrohysteropexy is a unilateral procedure, and reports have indicated an increased risk of uterine torsion due to alterations in the vaginal axis and a higher prevalence of constipation in these cases[20-22]. In bilateral pectopexy, abdominocervicopexy, and our LLS technique, there is no risk of uterine artery Doppler distortion or torsion[23]. Although vaginal approaches are less invasive in POP surgery, the incidence of mesh-related complications is reportedly high, particularly during sexual activity [24]. Pregnancy is contraindicated following sacrohysteropexy due to the potential for pain, the burden of the growing uterus, and the possibility of obstetric complications [25]. In the study, patients who underwent LLS reported only flank pain; however, no objective evaluation was conducted. In a study conducted by Joshi et al ., the pectineal ligament hysteropexy method was applied to patients with pelvic organ prolapse, resulting in pregnancy in 46 patients. Seven patients (15%) experienced a recurrence postpartum, with all instances occurring following a vaginal delivery. Kripalani et al. (2016) reported a recurrence rate of 18% (2/11 patients)[14]. Salem et al. (2015) reported a recurrence rate of 21% in 19 patients who underwent anterior abdominal wall cervicopexy (AAWCP). Cavkaytar et al. [15] reported a POP recurrence rate of 12.5% after cesarean section, while another study reported a recurrence rate of 20% after vaginal delivery. Pandeva et al. [26] reported that six of the seven patients (86%) exhibited stage 0 apical prolapse at the six-month postpartum follow-up in patients who underwent laparoscopic sacrocervicopexy. In a series of five patients who underwent transvaginal sacrospinous hysteropexy (or cervicocolpopexy) performed by Kovac et al., recurrence was observed in one patient who had delivered vaginally. In a cohort study, Sato et al. [27] reported a recurrence rate of 4.2% for POP after laparoscopic sacrocolpopexy. Other cases have been documented in the literature, with one or two instances reported. In our study, recurrence was observed in only one of 11 pregnant women (9%). Given the limited number of cases included in our study and the retrospective nature of the data collection, it is difficult to draw definitive conclusions regarding the recurrence of prolapse following delivery. This is the first study to report on pregnancy outcomes following LLS. The data will contribute to the existing literature on this topic. Conclusion Laparoscopic lateral suspension (LLS) is an effective treatment option for young patients with pelvic organ prolapse (POP) who desire fertility. Its efficacy in treating POP and low recurrence rates after pregnancy make it a suitable choice for these patients. It is recommended that an elective cesarean section be offered to patients who become pregnant after undergoing laparoscopic lateral suspension (LLS) due to the increased risk of failure of the procedure during vaginal delivery. Nevertheless, further, larger-scale, long-term studies are required. Declarations This retrospective study was reviewed by the Ethics Committee of Istanbul Training and Research Hospital, which stated that ethical approval was not required due to the retrospective nature of the study. Acknowledgment : We would like to extend our appreciation to everyone who assisted us in the writing of this manuscript. We also thank all the peer reviewers for their valuable feedback and recommendations. Author Contributions: EED and EE designed the research study. EE analyzed the data. Both authors conducted a literature review. All authors played a role in making editorial revisions to the manuscript. Each author has reviewed and approved the final version. All authors have engaged sufficiently in the project and have consented to take responsibility for all facets of the work. Availability of Data and Materials: Data supporting the findings of this study are available from the corresponding author upon request. Ethics Approval and Consent to Participate: Written informed consent was obtained from the patient for publication of this article and any accompanying images Funding: This research received no external funding. Conflict of Interest : The authors declare no conflict of interest. Ethics All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the Helsinki Declaration of 1975, as revised in 2000. Written informed consent was obtained from the patient or the patient’s legal guardians for the publication of these cases and any accompanying images. 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Martinello R, Scutiero G, Stuto A, Indraccolo U, Cracco F, Borghi C, Sorrentino F, Nappi L, Greco P: Correction of pelvic organ prolapse by laparoscopic lateral suspension with mesh: a clinical series . European Journal of Obstetrics & Gynecology and Reproductive Biology 2019, 240 :351-356. Joshi VM, Otiv SR, Dagade VB, Borse M, Majumder RN, Shrivastava M, Shelmohkar R, Bijwe S: Pectineal ligament hysteropexy for uterine prolapse in premenopausal women by open and laparoscopic approach in Indian urban and rural centers . Urogynecology 2015, 21 (4):215-219. Salem HT, Tawfik RM, El Saman AM, Nasr A: Anterior abdominal wall cervicopexy for treatment of stage III and stage IV uterine prolapse . International Journal of Gynecology & Obstetrics 2010, 110 (2):130-132. Kriplani A, Dalal V, Mahey R, Kachhawa G, Thariani K, Kriplani I, Vanamail P, Sharma JB: Long-term outcome of laparoscopic sacrohysteropexy for uterovaginal prolapse in young women . Journal of Gynecologic Surgery 2019, 35 (1):5-11. Cavkaytar S, Kokanalı MK, Tasdemir U, Doganay M, Aksakal O: Pregnancy outcomes after transvaginal sacrospinous hysteropexy . European Journal of Obstetrics & Gynecology and Reproductive Biology 2017, 216 :204-207. Kovac SR, Cruikshank SH: Successful pregnancies and vaginal deliveries after sacrospinous uterosacral fixation in five of nineteen patients . American journal of obstetrics and gynecology 1993, 168 (6):1778-1786. Adegoke TM, Vragovic O, Yarrington CD, Larrieux J-R: Effect of pregnancy on uterine-sparing pelvic organ prolapse repair . International Urogynecology Journal 2020, 31 :657-662. Wieslander CK, Weinstein MM, Handa VL, Collins SA: Pregnancy in women with prior treatments for pelvic floor disorders . Urogynecology 2020, 26 (5):299-305. Food, Administration D: Urogynecologic surgical mesh. update on the safety and effectiveness of transvaginal placement for pelvic organ prolapse . http://www fda gov/downloads/MedicalDevices/Safety/AlettsandNotices/UCM262760 pdf 2011. Ridgeway BM: Does prolapse equal hysterectomy? The role of uterine conservation in women with uterovaginal prolapse . American Journal of Obstetrics and Gynecology 2015, 213 (6):802-809. Jefferis H, Price N, Jackson S: Laparoscopic hysteropexy: 10 years’ experience . International urogynecology journal 2017, 28 :1241-1248. Noé K-G, Schiermeier S, Alkatout I, Anapolski M: Laparoscopic pectopexy: a prospective, randomized, comparative clinical trial of standard laparoscopic sacral colpocervicopexy with the new laparoscopic pectopexy—postoperative results and intermediate-term follow-up in a pilot study . Journal of endourology 2015, 29 (2):210-215. Mohamed-Suphan N, Ng RKW: Uterine prolapse complicating pregnancy and labor: a case report and literature review . International urogynecology journal 2012, 23 :647-650. Delarue E, Collinet P, Sabban F, Lucot J-P, Cosson M: Traitement du prolapsus génital chez la femme jeune: voie vaginale ou voie cœlioscopique? Gynécologie obstétrique & fertilité 2008, 36 (10):1043-1049. Samantray SR, Mohapatra I: Successful Pregnancy Outcome After Laparoscopic Sacrohysteropexy for Pelvic Organ Prolapse . Cureus 2021, 13 (2). Pandeva I, Mistry M, Fayyad A: Efficacy and pregnancy outcomes of laparoscopic single sheet mesh sacrohysteropexy . Neurourology and urodynamics 2017, 36 (3):787-793. Sato H, Otsuka S, Abe H, Tsukada S: Medium-term outcomes 2 years after laparoscopic sacrocolpopexy: a retrospective cohort study in Japan . Journal of Obstetrics and Gynaecology 2022, 42 (7):3336-3341. Tables Table 1) Demographic and pregnancy outcome data of patients. Patient Age BMI Before birth Time interval between LLS/ delivery (mounth) Outcames Complication 1. 36 32 NVD, G3P2 3 C/S, 37.week healty N 2. 29 26 NVD, G2P1 18 C/S 38.week healty N 3. 39 27 NVD, G6P4 4 C/S, 32.week Prom Preterm birth 4. 32 25 NVD, G2P1 20 C/S 38 week healty N 5. 35 30 NVD, C/S G3P2 12 C/S, 39.week healty N 6. 30 23 NVD, G4P2 10 C/S 38 week healty N 7. 28 20 NVD, G5P4 5 C/S, 35. week preterm Preterm birth 8. 31 23 NVD, G3P2 9 C/S, 39.week healty N 9. 35 28 NVD, G2P1 14 C/S, 39.week healty N 10. 39 29 NVD, G4P3 5 Abortus 13.week Abortus 11. 37 30 NVD, G3P2 8 C/S 37.week N Mean/ Median Std. (Min/Max) 35 3.9 (28-39) 26.6 3.6 (20-32) 3 1.2 (2-6) 3 1 (1-4) 9.8 5.6 (3-20) 35 7.6 (13-39) Table 2) Pelvic organ prolapse data of patients before prolapse surgery and after delivery . Patient Before prolapse surgery. POP-Q After delivery 3.mounth POP-Q After delivery 6.mounth POP-Q 1. Aa: +2, Ba: +1, C: +1 Gh: 2.5, Pb: 2.5, TVL: 9, Ap: 0.5, Bp: 0 D: -7,5 Stage 3- anterior wall normal normal 2. Aa: 0.0, Ba: +1, C: +1.5 Gh: 3.0, Pb: 2.0, TVL: 10, Ap: -0.5, Bp: -05, D:-8.0 Stage 3- uteine normal normal 3. Aa: 2.0, Ba: +2.5, C: +2.0 Gh: 4.0, Pb: 2.5, TVL: 11, Ap: 1.5, Bp: 1.0, D:-7.0 Stage 3- anterior wall normal normal 4. Aa: +3.0, Ba: +4.0, C: +3.0 Gh: 3.0, Pb: 2.0, TVL: 9.5, Ap: 0.0, Bp: 0.5 D: -6,5 Stage 3- anterior wall normal normal 5. Aa: 1.0, Ba:0.0, C: -1.5. Gh: 2.5, Pb: 3.5, TVL: 9.0, Ap: -2.5, Bp: -2.0, D: -8,5 Stage 2- anterior wall normal normal 6. Aa: 3.0, Ba:5.0, C: 2.5. Gh: 4.0, Pb: 1.5, TVL: 10, Ap: -1.5, Bp: 0.5, D: -6,5 Stage 3- anterior wall normal normal 7. Aa: 1.5, Ba:1.0, C:-3.0. Gh: 3.0, Pb:2.0, TVL: 8.0, Ap: -1.5, Bp: -0.5, D: -7.5 Stage 3- anterior wall normal normal 8. Aa: 2.5, Ba:2.0, C:1.0. Gh: 4.0, Pb:3.0, TVL: 7.0, Ap: 2.5, Bp: 2.5, D: -1.5 Stage 3- anterior / posterior wall Stage 2 Stage 2 9. Aa: 1.0, Ba:1.0, C:-5.0. Gh: 2.5, Pb:2.5, TVL: 8.5, Ap: -2.0, Bp: -1.0, D: -8.0 Stage 2- anterior wall normal normal 10. Aa: 2.0, Ba:2.5, C:1.0. Gh: 3, Pb:2.5, TVL: 8.0, Ap: 1.5, Bp:1.0, D: -3.0 Stage 3- anterior wall normal normal 11. Aa: 3.0, Ba:4.5, C:3.0. Gh: 3, Pb:4.0, TVL: 8.5, Ap: 2.0, Bp:2.5, D: -1.5 Stage 3- anterior wall normal normal Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7057434","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":481613264,"identity":"f8f314ff-4185-44e3-805a-5f169d5f7942","order_by":0,"name":"Emin Erhan DONMEZ","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYFACxgYgcYCBgR1EG1iQooXnAEiLBNFWAZVLJIAYRGjhFzvc9uDjnjvy5pLPr274USDBwN/enYBXi+TsxHbDGc+eGe6cnVN2swfoMIkzZzfg1WJwO7FNmufAYcYNt3PSbvAAtRhI5OLXYg/S8ufAYfsNN8+k3fxDjBYDaaAWhgOHEzfcYD92myhbJIC2SPYcOJy84UwO220ZAwkegn7hn53+TOLHgcO2G44ff3bzzR8bOf72XvxakACPAZgkVjkIsD8gRfUoGAWjYBSMIAAA4X9O8pOJOhIAAAAASUVORK5CYII=","orcid":"","institution":"Istanbul Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Emin","middleName":"Erhan","lastName":"DONMEZ","suffix":""},{"id":481613267,"identity":"3d3d34df-4519-4ed7-a5a1-a0fe15633548","order_by":1,"name":"Erkan ELCI","email":"","orcid":"","institution":"Istinye University of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Erkan","middleName":"","lastName":"ELCI","suffix":""}],"badges":[],"createdAt":"2025-07-06 11:23:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7057434/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7057434/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86319632,"identity":"646d57ce-495c-4899-9148-ae25f11016cf","added_by":"auto","created_at":"2025-07-09 09:27:21","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":238278,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea)\u003c/strong\u003e Endoscopic view showing the uterus (U) and bladder (B).\u003cstrong\u003e b)\u003c/strong\u003eEndoscopic view showing the dissection of the vesicovaginal space.\u003cstrong\u003e c)\u003c/strong\u003eFixation of the mesh (M) inside the abdomen with sutures.\u003cstrong\u003e d)\u003c/strong\u003eSite of the 3 mm skin incision for the retroperitoneal tunnel, indicated by the red dot at 2 cm above and 4 cm behind the Spina iliaca anterior (SIA) marked by the blue dot.\u003cstrong\u003e e)\u003c/strong\u003e Pulling the free arm of the mesh (M) through the created tunnels (indicated by the yellow dashed line).\u003cstrong\u003e f)\u003c/strong\u003eEndoscopic view showing the fixation site of the mesh and its path (indicated by the yellow dashed line).\u003c/p\u003e","description":"","filename":"Figure1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7057434/v1/672640562c24783606a429ac.jpeg"},{"id":86319618,"identity":"d5afb709-c6fc-484d-802f-8b0a2cdcd2b2","added_by":"auto","created_at":"2025-07-09 09:27:19","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":208069,"visible":true,"origin":"","legend":"\u003cp\u003ea) MRI image showing the Mesh indicated by red arrows.\u003cstrong\u003e \u003c/strong\u003eb) Ultrasonographic image of the Mesh indicated by red arrows.\u003cstrong\u003e \u003c/strong\u003ec) Image of the Mesh during cesarean section indicated by blue arrows.( U:uterus, B:bladder)\u003c/p\u003e","description":"","filename":"Figure2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7057434/v1/0cbe7ab19cd660fff481e79b.jpeg"},{"id":86320120,"identity":"26d6666f-4235-4353-a43e-52f4a555fa6a","added_by":"auto","created_at":"2025-07-09 09:34:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2107384,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7057434/v1/595524b7-122e-4eba-b13e-349b95cfe780.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pregnancy Results After Laparoscopic Lateral Suspension Surgery","fulltext":[{"header":"Background","content":"\u003cp\u003ePelvic organ prolapse (POP) is a prevalent condition affecting a significant proportion of women throughout their lifespan, with a notable surge in prevalence, particularly following vaginal delivery[1, 2]. Pelvic organ prolapse (POP) is defined by the displacement of pelvic organs (e.g., the uterus, bladder, or bowel) into the vagina due to loss of anatomical support. Patients often express this as a palpable swelling. Such consequences may include adverse effects on sexual function and impaired bladder and bowel function. The lifetime risk of undergoing surgical intervention for POP is estimated to be between 9% and 11%, with projections indicating an anticipated increase in prevalence due to the aging population[3].\u003c/p\u003e\n\u003cp\u003eThe management of POP encompasses a range of options, including conservative approaches, mechanical methods, and surgical interventions, which are selected based on the degree of prolapse and associated symptoms[4]. The objective of surgical intervention is to reinstate the normal anatomy of the vagina, enhance bladder and bowel function, and safeguard sexual function[4, 5]. Vaginal hysterectomy is typically the preferred treatment method, but this approach is now less favored due to high recurrence rates and the desire to preserve fertility in young patients with fertility intentions. In contrast, techniques that spare the uterus, such as sacrohysteropexy, have gained popularity[6]. This technique entails the suspension of the uterus to the sacral promontory via the use of a synthetic mesh. It can be performed through a variety of methods, including laparotomy, laparoscopy, or robotic surgery. It is currently regarded as the gold standard in the surgical treatment of apical prolapse[7]. In recent years, surgical techniques such as lateral suspension and pectopexy have also been employed in the treatment of pelvic organ prolapse (POP).\u003c/p\u003e\n\u003cp\u003eThe application of laparoscopic minimally invasive surgeries in the treatment of pelvic organ prolapse (POP) offers several advantages, including reduced blood loss, enhanced anatomical visualization, and a shorter recovery period[7]. Nevertheless, there is limited data in the literature with regard to the outcomes of pregnancy and delivery following such surgical procedures. Some studies have indicated that surgical techniques utilizing mesh may be a relative contraindication for future fertility[8].\u003c/p\u003e\n\u003cp\u003eFurthermore, the prevalence of older pregnancies among women has increased, resulting in a concomitant rise in the number of women becoming pregnant after pelvic floor reconstructive surgery (POPS). The impact of pregnancy and delivery mode on the recurrence of pelvic floor dysfunction and symptoms following surgery represents a significant area of concern[9]. The extant literature on this topic comprises case reports and series focusing on stress urinary incontinence surgery, and comprehensive data are lacking.\u003c/p\u003e\n\u003cp\u003eThe lack of robust evidence renders it challenging to ascertain the optimal mode of delivery for women with a history of postpartum ovarian syndrome (POPS). A survey conducted by the American Urogynecological Society (AUGS) revealed that 40% of obstetricians and gynecologists consistently opt for a cesarean section (CS) in such instances. This is attributable to uncertainty regarding the safety of vaginal delivery.\u003c/p\u003e\n\u003cp\u003eIn conclusion, POP is a prevalent condition that has been linked to adverse effects on women\u0026apos;s health and quality of life. Advances in surgical techniques, particularly minimally invasive methods, have enhanced outcomes; however, the impact of postoperative pregnancies on these repairs remains poorly understood[9]. In this case series, the management and complications of pregnancies following LLS performed as POP surgery were evaluated in the context of the existing literature. \u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eAll procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the Helsinki Declaration of 1975, as revised in 2000. This study is a retrospective analysis of 11 cases and all data were collected from existing medical records and were anonymized to ensure patient confidentiality, in accordance with institutional and national ethical guidelines.\u0026nbsp;Written informed consent was obtained from the patient or the patient\u0026rsquo;s legal guardians for the publication of these cases and any accompanying images.\u003c/p\u003e\n\u003cp\u003eAll LLS operations for patients who became pregnant were performed by a surgeon with 15 years of experience using the same method (E. ELCI). At the first visit and at each outpatient postoperative follow-up visit, the degree of prolapse was objectively assessed with maximum valsalva by the senior author (E.E.). The International Continence Society Pelvic Organ Prolapse Quantification System (POP-Q) was used for prolapse staging[10].\u003c/p\u003e\n\u003cp\u003eThis was a retrospective cohort study. Electronic data from 125 patients who underwent laparoscopic lateral suspension between 2020-2022 were collected. Seventy-three patients were of reproductive age and did not undergo tubal ligation or salpingectomy; 11 of these patients became pregnant after LLS. In these 11 cases, informed consent (which was obtained from the patient or her legal guardian) was collected for this study. The age of the cases (years), body mass index (BMI) (kg/m\u0026sup2;), time between operation and pregnancy (months), last birth (NVD, C/S), and before operation and after birth stage uterine prolapse according to the pelvic organ prolapse quantification (POP-Q) system results were collected. In addition to this, preoperative suspected diagnoses, surgical techniques, postoperative diagnosis, treatment, and surgical photos, if any, were collected. The data were collected, and in data analysis, the mean and standard deviation were calculated for continuous variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe surgical procedure was performed following the steps described in previous publications[11]. \u0026nbsp; \u003cstrong\u003eStep 1\u003c/strong\u003e: Anterior dissection of the vesicovaginal space is performed endoscopically (Fig.1a) to the most distal point possible (Fig.1b). \u003cstrong\u003eStep 2:\u003c/strong\u003e A T- or V-shaped Polypropylene Mesh (Mesh, Ethicon, Johnson \u0026amp; Johnson) consisting of a rectangular center (approx. 4 - 6 cm) and two long side arms (approx. 2*18 cm) is placed into the abdomen (Fig.1c). \u003cstrong\u003eStep 3\u003c/strong\u003e: The mesh is fixed to the dissected area from the center with the help of Taker or suture (Fig.1d). \u003cstrong\u003eStep 4\u003c/strong\u003e: A 3 mm skin incision is made 2 cm above the iliac crest and 4 cm behind the anterior superior iliac spine (ASIS) on both sides to create retroperitoneal canals (Fig.1e). \u003cstrong\u003eStep 5\u003c/strong\u003e: Mesh arms are pulled from the created retroperitoneal canal and left free and tension is provided with retroperitoneal fibrosis (Fig.1f).\u003c/p\u003e\n\u003cp\u003eThe anatomical localization of the mesh during pregnancy is shown by magnetic resonance imaging (MRI) (Fig.2a) and ultrasonography (Fig.2b), while its appearance during cesarean section is shown in (Fig.2c).\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe demographic and pregnancy outcome data of eleven patients are presented in Table 1. Of the 11 patients who became pregnant, only one resulted in a spontaneous abortion, and two patients experienced preterm labor. All deliveries were conducted via cesarean section.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 presents a summary of the data pertaining to pelvic organ prolapse in patients prior to prolapse surgery and following delivery. \u0026nbsp; The patients were observed at three- and six-month intervals following delivery, and only one case (9%) demonstrated evidence of recurrence. All patients underwent cesarean section in order to reduce the risk of recurrence. No difficulties or complications were encountered during the cesarean section.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our case study, 125 patients underwent LLS, and 53 of them did not undergo tubal ligation. Postoperative pregnancy occurred in 11 of these patients. Only one patient had a spontaneous miscarriage, and two had preterm labor. Recurrence was observed in only one patient (9%) at three- and six-month follow-up.\u003c/p\u003e\n\u003cp\u003eThe majority of studies on pregnancy following POP surgery are case-based. In the most comprehensive of these studies, 46 patients underwent open or laparoscopic sacrohysteropexy[12], 19 patients underwent anterior abdominal wall cervicopexy[13], and 11 patients underwent laparoscopic single mesh sacrohysteropexy[14]. The surgical procedure of sacrohysteropexy has been primarily focused on patients with uterine prolapse who also have a desire to become pregnant. In the context of existing literature, our study represents the inaugural investigation into pregnancy outcomes following LLS in 11 cases.\u003c/p\u003e\n\u003cp\u003eRegarding delivery methods after POP surgery, although there is no general rule, expert opinions are in favor of cesarean section. Cavkaytar \u003cem\u003eet al\u003c/em\u003e. reported that cesarean section was a safe and satisfactory method in women who underwent transvaginal sacrospinous hysteropexy (n=8) [15]. Kovac \u003cem\u003eet al\u003c/em\u003e. preferred vaginal delivery in women undergoing the same surgery (n=5) [16]. With the rationale of preventing disruption of reconstructed pelvic support, the current literature generally indicates cesarean section as the preferred mode of delivery [17]. Since there is no consensus in the literature on the mode of delivery, we recommended the cesarean section in all cases in our study.\u003c/p\u003e\n\u003cp\u003eIn sacrocolpopexy cases, which are more frequently reported in the literature, serious complications have been observed, including pain, discomfort, and, in some instances, erosion of the vaginal wall due to adhesion formation and intestinal obstruction caused by alloplastic materials [18, 19]. The use of mesh in the operation, particularly when wrapped around the isthmus, may theoretically result in compression of the uterine arteries, potentially leading to a disruption in uterine blood supply, which is essential for uterine growth and fetal development. Additionally, sacrohysteropexy is a unilateral procedure, and reports have indicated an increased risk of uterine torsion due to alterations in the vaginal axis and a higher prevalence of constipation in these cases[20-22]. In bilateral pectopexy, abdominocervicopexy, and our LLS technique, there is no risk of uterine artery Doppler distortion or torsion[23]. Although vaginal approaches are less invasive in POP surgery, the incidence of mesh-related complications is reportedly high, particularly during sexual activity [24]. Pregnancy is contraindicated following sacrohysteropexy due to the potential for pain, the burden of the growing uterus, and the possibility of obstetric complications [25]. In the study, patients who underwent LLS reported only flank pain; however, no objective evaluation was conducted.\u003c/p\u003e\n\u003cp\u003eIn a study conducted by Joshi \u003cem\u003eet al\u003c/em\u003e., the pectineal ligament hysteropexy method was applied to patients with pelvic organ prolapse, resulting in pregnancy in 46 patients. Seven patients (15%) experienced a recurrence postpartum, with all instances occurring following a vaginal delivery. Kripalani \u003cem\u003eet al.\u003c/em\u003e (2016) reported a recurrence rate of 18% (2/11 patients)[14]. Salem \u003cem\u003eet al.\u003c/em\u003e (2015) reported a recurrence rate of 21% in 19 patients who underwent anterior abdominal wall cervicopexy (AAWCP). Cavkaytar \u003cem\u003eet al.\u003c/em\u003e[15] reported a POP recurrence rate of 12.5% after cesarean section, while another study reported a recurrence rate of 20% after vaginal delivery. Pandeva \u003cem\u003eet al.\u003c/em\u003e [26] reported that six of the seven patients (86%) exhibited stage 0 apical prolapse at the six-month postpartum follow-up in patients who underwent laparoscopic sacrocervicopexy. In a series of five patients who underwent transvaginal sacrospinous hysteropexy (or cervicocolpopexy) performed by Kovac \u003cem\u003eet al.,\u003c/em\u003e recurrence was observed in one patient who had delivered vaginally. In a cohort study, Sato \u003cem\u003eet al.\u003c/em\u003e [27] reported a recurrence rate of 4.2% for POP after laparoscopic sacrocolpopexy. Other cases have been documented in the literature, with one or two instances reported. In our study, recurrence was observed in only one of 11 pregnant women (9%).\u003c/p\u003e\n\u003cp\u003eGiven the limited number of cases included in our study and the retrospective nature of the data collection, it is difficult to draw definitive conclusions regarding the recurrence of prolapse following delivery. This is the first study to report on pregnancy outcomes following LLS. The data will contribute to the existing literature on this topic.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eLaparoscopic lateral suspension (LLS) is an effective treatment option for young patients with pelvic organ prolapse (POP) who desire fertility. Its efficacy in treating POP and low recurrence rates after pregnancy make it a suitable choice for these patients. It is recommended that an elective cesarean section be offered to patients who become pregnant after undergoing laparoscopic lateral suspension (LLS) due to the increased risk of failure of the procedure during vaginal delivery. Nevertheless, further, larger-scale, long-term studies are required.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cspan\u003eThis retrospective study was reviewed by the Ethics Committee of Istanbul Training and Research Hospital, which stated that ethical approval was not required due to the retrospective nature of the study.\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAcknowledgment :\u003c/strong\u003e \u003c/p\u003e\n\u003cp\u003eWe would like to extend our appreciation to everyone who assisted us in the writing of this manuscript. We also thank all the peer reviewers for their valuable feedback and recommendations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEED and EE designed the research study. EE analyzed the data. Both authors conducted a literature review. All authors played a role in making editorial revisions to the manuscript. Each author has reviewed and approved the final version. All authors have engaged sufficiently in the project and have consented to take responsibility for all facets of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData supporting the findings of this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this article and any accompanying images\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest :\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the Helsinki Declaration of 1975, as revised in 2000. Written informed consent was obtained from the patient or the patient\u0026rsquo;s legal guardians for the publication of these cases and any accompanying images.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSmith FJ, Holman CAJ, Moorin RE, Tsokos N: \u003cstrong\u003eLifetime risk of undergoing surgery for pelvic organ prolapse\u003c/strong\u003e. \u003cem\u003eObstetrics \u0026amp; Gynecology \u003c/em\u003e2010, \u003cstrong\u003e116\u003c/strong\u003e(5):1096-1100.\u003c/li\u003e\n\u003cli\u003eHendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A: \u003cstrong\u003ePelvic organ prolapse in the Women\u0026apos;s Health Initiative: gravity and gravidity\u003c/strong\u003e. \u003cem\u003eAmerican journal of obstetrics and gynecology \u003c/em\u003e2002, \u003cstrong\u003e186\u003c/strong\u003e(6):1160-1166.\u003c/li\u003e\n\u003cli\u003eOlsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL: \u003cstrong\u003eEpidemiology of surgically managed pelvic organ prolapse and urinary incontinence\u003c/strong\u003e. \u003cem\u003eObstetrics \u0026amp; 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Gynecology and Reproductive Biology \u003c/em\u003e2010, \u003cstrong\u003e151\u003c/strong\u003e(1):10-13.\u003c/li\u003e\n\u003cli\u003eHegde A, Huebner M, Ibrahim S, Mastrolia SA, David-Montefiore E, Weintraub AY: \u003cstrong\u003eImpact of childbirth on pelvic floor dysfunction in women who have undergone previous pelvic floor reconstructive surgery: systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eInternational Urogynecology Journal \u003c/em\u003e2024, \u003cstrong\u003e35\u003c/strong\u003e(1):3-17.\u003c/li\u003e\n\u003cli\u003eRc B: \u003cstrong\u003eThe standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction\u003c/strong\u003e. \u003cem\u003eAm J Obstet Gynecol \u003c/em\u003e1996, \u003cstrong\u003e175\u003c/strong\u003e:10-17.\u003c/li\u003e\n\u003cli\u003eMartinello R, Scutiero G, Stuto A, Indraccolo U, Cracco F, Borghi C, Sorrentino F, Nappi L, Greco P: \u003cstrong\u003eCorrection of pelvic organ prolapse by laparoscopic lateral suspension with mesh: a clinical series\u003c/strong\u003e. \u003cem\u003eEuropean Journal of Obstetrics \u0026amp; Gynecology and Reproductive Biology \u003c/em\u003e2019, \u003cstrong\u003e240\u003c/strong\u003e:351-356.\u003c/li\u003e\n\u003cli\u003eJoshi VM, Otiv SR, Dagade VB, Borse M, Majumder RN, Shrivastava M, Shelmohkar R, Bijwe S: \u003cstrong\u003ePectineal ligament hysteropexy for uterine prolapse in premenopausal women by open and laparoscopic approach in Indian urban and rural centers\u003c/strong\u003e. \u003cem\u003eUrogynecology \u003c/em\u003e2015, \u003cstrong\u003e21\u003c/strong\u003e(4):215-219.\u003c/li\u003e\n\u003cli\u003eSalem HT, Tawfik RM, El Saman AM, Nasr A: \u003cstrong\u003eAnterior abdominal wall cervicopexy for treatment of stage III and stage IV uterine prolapse\u003c/strong\u003e. \u003cem\u003eInternational Journal of Gynecology \u0026amp; Obstetrics \u003c/em\u003e2010, \u003cstrong\u003e110\u003c/strong\u003e(2):130-132.\u003c/li\u003e\n\u003cli\u003eKriplani A, Dalal V, Mahey R, Kachhawa G, Thariani K, Kriplani I, Vanamail P, Sharma JB: \u003cstrong\u003eLong-term outcome of laparoscopic sacrohysteropexy for uterovaginal prolapse in young women\u003c/strong\u003e. \u003cem\u003eJournal of Gynecologic Surgery \u003c/em\u003e2019, \u003cstrong\u003e35\u003c/strong\u003e(1):5-11.\u003c/li\u003e\n\u003cli\u003eCavkaytar S, Kokanalı MK, Tasdemir U, Doganay M, Aksakal O: \u003cstrong\u003ePregnancy outcomes after transvaginal sacrospinous hysteropexy\u003c/strong\u003e. \u003cem\u003eEuropean Journal of Obstetrics \u0026amp; Gynecology and Reproductive Biology \u003c/em\u003e2017, \u003cstrong\u003e216\u003c/strong\u003e:204-207.\u003c/li\u003e\n\u003cli\u003eKovac SR, Cruikshank SH: \u003cstrong\u003eSuccessful pregnancies and vaginal deliveries after sacrospinous uterosacral fixation in five of nineteen patients\u003c/strong\u003e. \u003cem\u003eAmerican journal of obstetrics and gynecology \u003c/em\u003e1993, \u003cstrong\u003e168\u003c/strong\u003e(6):1778-1786.\u003c/li\u003e\n\u003cli\u003eAdegoke TM, Vragovic O, Yarrington CD, Larrieux J-R: \u003cstrong\u003eEffect of pregnancy on uterine-sparing pelvic organ prolapse repair\u003c/strong\u003e. \u003cem\u003eInternational Urogynecology Journal \u003c/em\u003e2020, \u003cstrong\u003e31\u003c/strong\u003e:657-662.\u003c/li\u003e\n\u003cli\u003eWieslander CK, Weinstein MM, Handa VL, Collins SA: \u003cstrong\u003ePregnancy in women with prior treatments for pelvic floor disorders\u003c/strong\u003e. \u003cem\u003eUrogynecology \u003c/em\u003e2020, \u003cstrong\u003e26\u003c/strong\u003e(5):299-305.\u003c/li\u003e\n\u003cli\u003eFood, Administration D: \u003cstrong\u003eUrogynecologic surgical mesh. update on the safety and effectiveness of transvaginal placement for pelvic organ prolapse\u003c/strong\u003e. \u003cem\u003ehttp://www\u003c/em\u003e\u003cem\u003e fda gov/downloads/MedicalDevices/Safety/AlettsandNotices/UCM262760 pdf \u003c/em\u003e2011.\u003c/li\u003e\n\u003cli\u003eRidgeway BM: \u003cstrong\u003eDoes prolapse equal hysterectomy? The role of uterine conservation in women with uterovaginal prolapse\u003c/strong\u003e. \u003cem\u003eAmerican Journal of Obstetrics and Gynecology \u003c/em\u003e2015, \u003cstrong\u003e213\u003c/strong\u003e(6):802-809.\u003c/li\u003e\n\u003cli\u003eJefferis H, Price N, Jackson S: \u003cstrong\u003eLaparoscopic hysteropexy: 10 years\u0026rsquo; experience\u003c/strong\u003e. \u003cem\u003eInternational urogynecology journal \u003c/em\u003e2017, \u003cstrong\u003e28\u003c/strong\u003e:1241-1248.\u003c/li\u003e\n\u003cli\u003eNo\u0026eacute; K-G, Schiermeier S, Alkatout I, Anapolski M: \u003cstrong\u003eLaparoscopic pectopexy: a prospective, randomized, comparative clinical trial of standard laparoscopic sacral colpocervicopexy with the new laparoscopic pectopexy\u0026mdash;postoperative results and intermediate-term follow-up in a pilot study\u003c/strong\u003e. \u003cem\u003eJournal of endourology \u003c/em\u003e2015, \u003cstrong\u003e29\u003c/strong\u003e(2):210-215.\u003c/li\u003e\n\u003cli\u003eMohamed-Suphan N, Ng RKW: \u003cstrong\u003eUterine prolapse complicating pregnancy and labor: a case report and literature review\u003c/strong\u003e. \u003cem\u003eInternational urogynecology journal \u003c/em\u003e2012, \u003cstrong\u003e23\u003c/strong\u003e:647-650.\u003c/li\u003e\n\u003cli\u003eDelarue E, Collinet P, Sabban F, Lucot J-P, Cosson M: \u003cstrong\u003eTraitement du prolapsus g\u0026eacute;nital chez la femme jeune: voie vaginale ou voie c\u0026oelig;lioscopique?\u003c/strong\u003e \u003cem\u003eGyn\u0026eacute;cologie obst\u0026eacute;trique \u0026amp; fertilit\u0026eacute; \u003c/em\u003e2008, \u003cstrong\u003e36\u003c/strong\u003e(10):1043-1049.\u003c/li\u003e\n\u003cli\u003eSamantray SR, Mohapatra I: \u003cstrong\u003eSuccessful Pregnancy Outcome After Laparoscopic Sacrohysteropexy for Pelvic Organ Prolapse\u003c/strong\u003e. \u003cem\u003eCureus \u003c/em\u003e2021, \u003cstrong\u003e13\u003c/strong\u003e(2).\u003c/li\u003e\n\u003cli\u003ePandeva I, Mistry M, Fayyad A: \u003cstrong\u003eEfficacy and pregnancy outcomes of laparoscopic single sheet mesh sacrohysteropexy\u003c/strong\u003e. \u003cem\u003eNeurourology and urodynamics \u003c/em\u003e2017, \u003cstrong\u003e36\u003c/strong\u003e(3):787-793.\u003c/li\u003e\n\u003cli\u003eSato H, Otsuka S, Abe H, Tsukada S: \u003cstrong\u003eMedium-term outcomes 2 years after laparoscopic sacrocolpopexy: a retrospective cohort study in Japan\u003c/strong\u003e. \u003cem\u003eJournal of Obstetrics and Gynaecology \u003c/em\u003e2022, \u003cstrong\u003e42\u003c/strong\u003e(7):3336-3341.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1)\u0026nbsp;\u003c/strong\u003eDemographic and pregnancy outcome \u0026nbsp; data of patients.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003ePatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eBefore birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eTime interval\u003c/p\u003e\n \u003cp\u003ebetween\u003c/p\u003e\n \u003cp\u003eLLS/ delivery\u003c/p\u003e\n \u003cp\u003e(mounth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eOutcames\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eComplication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNVD,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eG3P2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eC/S,\u003c/p\u003e\n \u003cp\u003e37.week\u003c/p\u003e\n \u003cp\u003ehealty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNVD,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eG2P1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003cp\u003e38.week\u003c/p\u003e\n \u003cp\u003ehealty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNVD,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eG6P4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eC/S,\u003c/p\u003e\n \u003cp\u003e32.week\u003c/p\u003e\n \u003cp\u003eProm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003ePreterm birth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e4.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNVD,\u003c/p\u003e\n \u003cp\u003eG2P1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003cp\u003e38 week\u003c/p\u003e\n \u003cp\u003ehealty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNVD,\u003c/p\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003cp\u003eG3P2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eC/S,\u003c/p\u003e\n \u003cp\u003e39.week\u003c/p\u003e\n \u003cp\u003ehealty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e6.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNVD,\u003c/p\u003e\n \u003cp\u003eG4P2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003cp\u003e38 week\u003c/p\u003e\n \u003cp\u003ehealty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e7.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNVD,\u003c/p\u003e\n \u003cp\u003eG5P4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eC/S,\u003c/p\u003e\n \u003cp\u003e35. week\u003c/p\u003e\n \u003cp\u003epreterm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003ePreterm birth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e8.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNVD,\u003c/p\u003e\n \u003cp\u003eG3P2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eC/S,\u003c/p\u003e\n \u003cp\u003e39.week\u003c/p\u003e\n \u003cp\u003ehealty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e9.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNVD,\u003c/p\u003e\n \u003cp\u003eG2P1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eC/S,\u003c/p\u003e\n \u003cp\u003e39.week\u003c/p\u003e\n \u003cp\u003ehealty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNVD,\u003c/p\u003e\n \u003cp\u003eG4P3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eAbortus\u003c/p\u003e\n \u003cp\u003e13.week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eAbortus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e11.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNVD,\u003c/p\u003e\n \u003cp\u003eG3P2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003cp\u003e37.week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eMean/\u003c/p\u003e\n \u003cp\u003eMedian Std.\u003c/p\u003e\n \u003cp\u003e(Min/Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(28-39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e26.6\u003c/p\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(20-32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(2-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(3-20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(13-39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2) Pelvic organ prolapse data of patients before prolapse surgery and after delivery\u003c/strong\u003e.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"641\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003ePatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBefore \u0026nbsp;prolapse surgery.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003ePOP-Q\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003cp\u003edelivery\u003c/p\u003e\n \u003cp\u003e3.mounth\u003c/p\u003e\n \u003cp\u003ePOP-Q\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003cp\u003edelivery\u003c/p\u003e\n \u003cp\u003e6.mounth\u003c/p\u003e\n \u003cp\u003ePOP-Q\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAa: +2, Ba: +1, C: +1\u003c/p\u003e\n \u003cp\u003eGh: 2.5, Pb: 2.5, TVL: 9,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAp: 0.5, Bp: 0 \u0026nbsp;D: -7,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eStage 3- anterior wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAa: 0.0, Ba: +1, C: +1.5\u003c/p\u003e\n \u003cp\u003eGh: 3.0, Pb: 2.0, TVL: 10,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAp: -0.5, Bp: -05, D:-8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eStage 3- uteine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAa: 2.0, Ba: +2.5, C: +2.0\u003c/p\u003e\n \u003cp\u003eGh: 4.0, Pb: 2.5, TVL: 11,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAp: 1.5, Bp: 1.0, D:-7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eStage 3- anterior wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e4.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAa: +3.0, Ba: +4.0, C: +3.0\u003c/p\u003e\n \u003cp\u003eGh: 3.0, Pb: 2.0, TVL: 9.5,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAp: 0.0, Bp: 0.5 \u0026nbsp;D: -6,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eStage 3- anterior wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAa: 1.0, Ba:0.0, C: -1.5.\u003c/p\u003e\n \u003cp\u003eGh: 2.5, Pb: 3.5, TVL: 9.0,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAp: -2.5, Bp: -2.0, D: -8,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eStage 2- anterior wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e6.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAa: 3.0, Ba:5.0, C: 2.5.\u003c/p\u003e\n \u003cp\u003eGh: 4.0, Pb: 1.5, TVL: 10,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAp: -1.5, Bp: 0.5, D: -6,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eStage 3- anterior wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e7.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAa: 1.5, Ba:1.0, C:-3.0.\u003c/p\u003e\n \u003cp\u003eGh: 3.0, Pb:2.0, TVL: 8.0,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAp: -1.5, Bp: -0.5, D: -7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eStage 3- anterior wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e8.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAa: 2.5, Ba:2.0, C:1.0.\u003c/p\u003e\n \u003cp\u003eGh: 4.0, Pb:3.0, TVL: 7.0,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAp: 2.5, Bp: 2.5, D: -1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eStage 3- anterior / posterior wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eStage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eStage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e9.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAa: 1.0, Ba:1.0, C:-5.0.\u003c/p\u003e\n \u003cp\u003eGh: 2.5, Pb:2.5, TVL: 8.5,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAp: -2.0, Bp: -1.0, D: -8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eStage 2- anterior wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAa: 2.0, Ba:2.5, C:1.0.\u003c/p\u003e\n \u003cp\u003eGh: 3, Pb:2.5, TVL: 8.0,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAp: 1.5, Bp:1.0, D: -3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eStage 3- anterior wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e11.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAa: 3.0, Ba:4.5, C:3.0.\u003c/p\u003e\n \u003cp\u003eGh: 3, Pb:4.0, TVL: 8.5,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAp: 2.0, Bp:2.5, D: -1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eStage 3- anterior wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Laparoscopic lateral suspension, POP, LLS, pregnancy","lastPublishedDoi":"10.21203/rs.3.rs-7057434/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7057434/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: This case series aims to investigate pregnancy results and pelvic organ prolapse (POP) recurrence after uterus-sparing laparoscopic lateral suspension (LLS) in fertility-seeking prolapse patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This is a single-center retrospective patient data review study. Between 2019 and 2022, 125 patients underwent LLS, and 20 of 73 patients of reproductive age underwent simultaneous bilateral tubal ligation (BTL). Pregnancy occurred in 11 of the remaining 53 patients, and the data of these women were analyzed. Data were obtained from the medical records of patients who underwent LLS and became pregnant after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of eleven women experienced a postoperative pregnancy, with one resulting in spontaneous abortion. Ten women proceeded with their pregnancies, and two resulted in premature delivery. All other babies exhibited a weight commensurate with their gestational age. The patients were offered an elective cesarean section in order to preserve the anatomical results of prolapse surgery. All deliveries were conducted via cesarean section, and no intraoperative complications were encountered during the incisions. The evaluations conducted at the three- and six-month follow-up visits following LLS were documented. One patient exhibited a recurrence of apical prolapse.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Patients with future fertility and symptomatic advanced pelvic organ prolapse (POP) represent an appropriate cohort for laparoscopic lateral suspension (LLS). The results of our study demonstrate the feasibility of LLS as an effective surgical technique. This procedure can be employed to treat patients with symptomatic pelvic organ prolapse while preserving fertility in young women.\u003c/p\u003e","manuscriptTitle":"Pregnancy Results After Laparoscopic Lateral Suspension Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-09 09:26:01","doi":"10.21203/rs.3.rs-7057434/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5c0a3621-d697-49eb-afcd-0feb15b1a951","owner":[],"postedDate":"July 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-12T09:23:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-09 09:26:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7057434","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7057434","identity":"rs-7057434","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}