New native tissue repair for pelvic organ prolapse: Medium-term outcomes of laparoscopic vaginal stump-round ligament fixation

Toshiyuki Kakinuma; Ayaka Kaneko; Kaoru Kakinuma; Ken Imai; Nobuhiro Takeshima; Michitaka Ohwada

doi:10.12998/wjcc.v11.i15.3457

New native tissue repair for pelvic organ prolapse: Medium-term outcomes of laparoscopic vaginal stump-round ligament fixation

World J Clin Cases. 2023 May 26;11(15):3457-3463. doi: 10.12998/wjcc.v11.i15.3457.

Authors

Toshiyuki Kakinuma¹, Ayaka Kaneko², Kaoru Kakinuma², Ken Imai², Nobuhiro Takeshima², Michitaka Ohwada²

Affiliations

¹ Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan. tokakinuma@gmail.com.
² Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan.

Abstract

Background: Laparoscopic sacrocolpopexy for pelvic organ prolapse (POP) is a new and widely used approach; however, ever since the United States Food and Drug Administration warned against the use of surgical mesh, repairs performed using patients' tissues [i.e. native tissue repair (NTR)] instead of mesh have attracted much attention. At our hospital, laparoscopic sacrocolpopexy (the Shull method) was introduced in 2017. However, patients with more severe POP who have a long vaginal canal and overextended uterosacral ligaments may not be candidates for this procedure.

Aim: To validate a new NTR treatment for POP, we examined patients undergoing laparoscopic vaginal stump-round ligament fixation (the Kakinuma method).

Methods: The study patients were 30 individuals with POP who underwent surgery using the Kakinuma method between January 2020 and December 2021 and who were followed up for > 12 mo after surgery. We retrospectively examined surgical outcomes for surgery duration, blood loss, intraoperative complications, and incidence of recurrence. The Kakinuma method involves round ligament suturing and fixation on both sides, effectively lifting the vaginal stump after laparoscopic hysterectomy.

Results: The patients' mean age was 66.5 ± 9.1 (45-82) years, gravidity was 3.1 ± 1.4 (2-7), parity was 2.5 ± 0.6 (2-4) times, and body mass index was 24.5 ± 3.3 (20.9-32.8) kg/m². According to the POP quantification stage classification, there were 8 patients with stage II, 11 with stage III, and 11 with stage IV. The mean surgery duration was 113.4 ± 22.6 (88-148) min, and the mean blood loss was 26.5 ± 39.7 (10-150) mL. There were no perioperative complications. None of the patients exhibited reduced activities of daily living or cognitive impairment after hospital discharge. No cases of POP recurrence were observed 12 mo after the operation.

Conclusion: The Kakinuma method, similar to conventional NTR, may be an effective treatment for POP.

Keywords: Kakinuma method; Laparoscopic surgery; Native tissue repair; Pelvic organ prolapse; Round ligament.