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Objective To evaluate the clinical effect of Tension-free laparoscopic lateral suspension with mesh for pelvic organ prolapse. Methods A total of 85 patients who underwent pelvic organ prolapse were selected as the study group, and 40 patients underwent Laparoscopic sacral fixation surgery(LSC) as the control group in Henan Provincial People's Hospital from March 1, 2021 to October 31, 2023. The patients were divided into two subgroups' uterine preservation group and uterine resection group and followed up until April 30, 2024. The intraoperative conditions and postoperative complications were recorded and analyzed. POP quantitative staging(POP-Q) scores were used for evaluation. Preoperative and postoperative quality of life and therapeutic effect were evaluated using the pelvic floor distress inventory short form-20(PFDI-20), urinary distress inventory-6 (UDI-6), colorectalanal distress inventory-8 (CRADI-8), pelvic organ prolapse distress inventory-6(POPDI-6), pelvic floor impact questionnaire-7(PFIQ-7), prolapse and Incontinence sexual function questionnaire short form(PISQ-12). Results The median follow-up time for patients in the study group is 13.13 months, with an objective cure rate of 96.47% and a reoperation rate of 1.18%. The perioperative complication rates are 6.45% for uterine resection and 4.35% for uterine preservation, while the mesh exposure rate is 1.61% for uterine resection. In comparison, the median follow-up time for patients in the control group is slightly longer at 13.76 months, with an objective cure rate of 92.5% and a reoperation rate of 2.5%. The perioperative complication rates are higher at 14.71% for uterine resection and as high as 33.33% for uterine preservation, while the mesh exposure rate is also elevated at 8.82% for uterine resection. Despite these differences, there was no significant disparity in objective cure rates or reoperation rates between the study group and the control group. Furthermore, it was observed that the study group experienced shorter operation times, less bleeding, faster postoperative recovery, shorter hospitalization periods, lower perioperative complications, and reduced mesh exposure rates -especially among patients with uterine preservation. Additionally, intra-group comparisons revealed significant improvements in all POP-Q indicators one year after surgery (P < 0.05), along with significantly lower scores on PFDI-20, UDI-6, CRADI-8, POPDI-6, PFIQ-7, and PISQ-12 scales compared to pre-surgery levels (P < 0.05). However, no significant inter-group differences were noted. Conclusions Tension-free laparoscopic lateral suspension with mesh proves to be an effective surgical approach for treating anteriorand middle pelvic organ prolapse. It demonstrates few perioperative complications while significantly improving prolapse symptoms and enhancing patient qualityof life. It stands as a viable alternative to sacrocolpopexy, particularly beneficial for patients with a preserved uterus. [ABSTRACT FROM AUTHOR]