| Summary: | <b>Objectives:</b> Pelvic organ prolapse (POP) is a common condition affecting women, often requiring surgical intervention. Laparoscopic pectopexy has gained popularity, but there is ongoing debate about the efficacy and safety of mesh versus thread as fixation materials. This study aims to compare the outcomes of these two techniques, focusing on cure, recurrence and postoperative complication rates. <b>Methods:</b> A prospective analysis was conducted on patients undergoing laparoscopic pectopexy for POP. This prospective study included 78 patients diagnosed with pelvic organ prolapse stage II–IV according to the POP-Q system. Thirty-six (46.15%) underwent laparoscopic pectopexy with mesh and forty-two patients (53.84%) underwent the laparoscopic pectopexy procedure with thread. Data on cure rates, recurrence, mild asymptomatic cystocele and chronic pain were analyzed. Statistical significance was assessed using chi-squared and Fisher’s exact tests. <b>Results:</b> The cure rate was high in both group: 94.4% in the Mesh group and 100% in the thread group. Recurrence of vaginal apex prolapse occurred in 5.56% of the Mesh group, while no recurrence was observed in the thread group. Chronic pain was reported in 11.11% of the Mesh group but was absent in the thread group (<i>p</i> < 0.05). The overall rate for cystocele across all participants was 44.87% (40.48% of patients in the thread group experienced mild asymptomatic cystocele, compared to 50% in the Mesh group). No intraoperative complications were reported in either group. <b>Conclusions:</b> Thread-based laparoscopic pectopexy demonstrates equivalent or superior outcomes compared to mesh, with a high cure rate, no recurrence rate and no chronic pain. These findings support the use of thread as a safer alternative, aligning with FDA guidelines on mesh usage.
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