Objective To explore the clinical efficacy and safety of three autologous tissue-based anterior vaginal wall repair for patients with anterior pelvic organ prolapse （POP），and to provide reference for the selection of surgical approaches. Methods A retrospective analysis was conducted on the clinical data of 88 patients with anterior POP who underwent surgical treatment at Foshan Maternal and Child Health Hospital from January 2017 to June 2023. All patients received the same surgical procedures for the middle and posterior compartments，including vaginal hysterectomy combined with right sacrospinous ligament fixation of the vaginal vault，posterior vaginal wall repair，and repair of old perineal lacerations. According to the anterior compartment repair technique，patients were divided into three groups： Group A （sacro-ligament-pubovaginal muscle cross-fixation，n=26），Group B （traditional anterior vaginal wall repair，n=31），and Group C （anterior vaginal fascial flap suspension to the pubic periosteum，n=31）. Baseline data，perioperative outcomes，changes in pelvic organ prolapse quantification （POP-Q） points before surgery and at 3 months postoperatively were compared and Pelvic Floor Distress Inventory-20 （PFDI-20） was used to evaluate life quality; meanwhile, postoperative complications were compared. Results There were no significant differences in baseline data or middle and posterior compartment POP-Q points among the three groups before surgery （P>0.05）. Significant differences were observed in preoperative anterior compartment points Aa and Ba （P<0.05），with more severe prolapse in Groups A and C than in Group B. At 3 months postoperatively，all POP-Q points and PFDI-20 scores in the three groups showed significant improvement compared with those before operation （P<0.05），while no significant differences were found in postoperative POP-Q points among the groups （P>0.05）. The postoperative PFDI-20 score in Group A was higher than that in Group B（P<0.05）. There were no significant differences in the incidence of long-term postoperative complications among the three groups （P>0.05）. Conclusions All three autologous tissue-based anterior vaginal wall repair procedures can effectively improve anatomical outcomes and quality of life in patients with anterior POP. Sacro-ligament-pubovaginal muscle cross-fixation is more suitable for patients with more severe anterior compartment prolapse; however，it is associated with relatively higher postoperative subjective pelvic floor distress，and appropriate selection of surgical procedure is required in clinical practice.