Pelvic organ prolapse (POP) is one of the most common diseases experienced by women during their lifetime, and especially during menopause. Specifically, the lifetime risk of pelvic organ prolapse ranges from 40-60%, while the risk of undergoing at least one prolapse reconstructive procedure approaches 12.6%.1 In fact, these aforementioned risks are expected to further increase over the next decades, making it imperative to develop techniques with good postoperative outcomes and low rates of perioperative complications.

Uterosacral ligament suspension (USLS) was initially described by Milner et al in 1927, and numerous surgical variants have been detailed since its inception. These variations are generally centered on the transvaginal plication or shortening of the uterosacral ligaments at their insertion into the cervix up to the level of the ischial spine. The procedure, which can be performed with or without synchronous hysterectomy and is classified as a native-tissue suspension technique, is among the commonly preferred apical suspension procedures. According to existing literature, vaginal uterosacral ligament suspension (V-USLS) demonstrates considerable effectiveness in restoring apical prolapse. It is noted to exhibit comparable postoperative outcomes to other frequently reported reconstructive procedures, such as sacrospinous ligament fixation and sacrocolpopexy.2

Laparoscopic uterosacral ligament suspension (L-USLS) occurred from the laparoscopic transposition of the traditional vaginal approach. In fact, few studies have established its viability, safety, and effectiveness as an alternative approach. Specifically, recent pooled literature data support that the anatomical and subjective success rates after L-USLS are ranging from 79% to 100% and from 76.2% to 100%, respectively. In addition, the overall rate of postoperative complications remains low.3 Even fewer are those studies that compare the laparoscopic technique with the vaginal approach in terms of postoperative outcomes and rates of postoperative complications.4–8 Therefore, there is an ongoing debate regarding which approach is preferable and more appropriate for certain patient populations.

The aim of the present meta-analysis is to analyze the existing evidence with intent to compare L-USLS and V-USLS for the management of patients with pelvic organ prolapse.