Objective: This study aimed to evaluate the efficacy and outcomes of visceral peritonization during laparoscopic Burch colposuspension in women with stress urinary incontinence (SUI). Methods: We conducted a retrospective cohort study involving 40 women who underwent laparoscopic Burch colposuspension at two tertiary centers. Patients were allocated into two groups: Group P (n = 20), in whom the peritoneum was closed over the colposuspension sutures, and Group NP (n = 20), in whom the peritoneum was left open. Primary outcomes included subjective and objective continence rates and postoperative adhesion formation, evaluated at 6 and 12 months using transvaginal ultrasound and pelvic MRI. Secondary outcomes encompassed operative time, estimated blood loss, length of hospital stay, and postoperative complications such as urinary retention and de novo urgency. Results: At 12-month follow-up, subjective continence was achieved in 90 % of patients in Group P and 85 % in Group NP (p = 0.63); objective cure rates were 85 % and 80 %, respectively (p = 0.68). Rates of significant adhesions identified on imaging were comparable between groups, and no cases of bowel entrapment were observed. Group NP had significantly shorter operative time (p = 0.003). No significant differences were noted in blood loss, hospital stay, or postoperative complication rates. Conclusion: In this small, underpowered, non-randomized study, laparoscopic Burch colposuspension performed with or without visceral peritonization showed no significant differences in continence or complication outcomes, although adhesion rates may have been underestimated due to imaging limitations. Omission of peritoneal closure was associated with a shorter operative time. These preliminary findings suggest that peritoneal closure could be omitted selectively in certain clinical scenarios, but larger prospective randomized studies are required to confirm these results.