Design: Retrospective longitudinal study was done at Tulip hospital, Haryana, India, between January 2020 to January 2023. Patient demographics , preoperative prolapse stage, intraoperative details, postoperative outcomes, and complications were analyzed. Anatomical success rates, subjective improvement in symptoms, and recurrence rates were compared between the two surgical techniques and follow up was done for one year.

Setting: Patients were placed in a modified lithotomy position, with the hips at an approximate 180° extension, the knees flexed at almost 90°, and with the table tilted in a nearly 45° Trendelenburg position

Patients or Participants: The study included 100 patients with apical prolapse, categorized into two groups: 65 patients underwent laparoscopic pectopexy, while 35 patients underwent high uterosacral ligament fixation with McCall's Culdoplasty.

Interventions: In laparoscopic pectopexy, a 15x15 cm H-shaped mesh was utilized, attached from the apical prolapse to the pectineal ligament. For high uterosacral ligament fixation,Ethibond suture was used for native tissue repair.

Measurements and Main Results: Among laparoscopic pectopexy patients, one developed SUI, another had mesh infection treated with antibiotics and laser therapy, and one experienced mesh erosion requiring removal. No prolapse recurrence was noted.

For native tissue repair patients, five with grade three prolapse required subsequent pectopexy with McCall's Culdoplasty due to failed management. These patients showed no complications or recurrence during follow-up.

Conclusion: Laparoscopic pectopexy offers superior outcomes and safety compared to native tissue repair, especially for grade three and procidentia cases. While pectopexy is simpler and enhances quality of life. Native tissue repair remains suitable for grades 0-2.