Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2023; 11(15): 3457-3463
Published online May 26, 2023. 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
Toshiyuki Kakinuma, Ayaka Kaneko, Kaoru Kakinuma, Ken Imai, Nobuhiro Takeshima, Michitaka Ohwada
Toshiyuki Kakinuma, Ayaka Kaneko, Kaoru Kakinuma, Ken Imai, Nobuhiro Takeshima, Michitaka Ohwada, Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
Author contributions: Kakinuma T contributed to methodology, software, validation, formal analysis, writing-original draft preparation, writing-review and editing, visualization, supervision, and project administration; Kakinuma T, Kakinuma K, Kaneko A, Imai K, Takeshima N, and Ohwada M collected data and performed the research; All authors contributed to investigation, resources, data curation, and read and agreed to the published version.
Institutional review board statement: The study was approved by the Ethics Committee of the International University of Health and Welfare Hospital, No. 21-B-463.
Informed consent statement: All patients provided written and oral informed consent for the procedure and study participation after a proper explanation of the risks and benefits of the surgical procedure.
Conflict-of-interest statement: All authors report having no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are included in this article and its supplementary material files. Further inquiries can be directed to the corresponding author at tokakinuma@gmail.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Toshiyuki Kakinuma, MD, PhD, Doctor, Professor, Department of Obstetrics and Gynecology, International University of Health and Welfare, 537-3, Iguchi, Nasushiobara 329-2763, Japan. tokakinuma@gmail.com
Received: January 9, 2023
Peer-review started: January 9, 2023
First decision: February 2, 2023
Revised: March 2, 2023
Accepted: April 14, 2023
Article in press: April 14, 2023
Published online: May 26, 2023
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: Pelvic organ prolapse, Native tissue repair, Laparoscopic surgery, Round ligament, Kakinuma method

Core Tip: The conventional method of performing repairs using patients’ own tissues [also called native tissue repair (NTR)] instead of using mesh is being reconsidered. NTR surgical techniques include vaginal stump–uterosacral ligament fixation (Shull method), which has reported satisfactory surgical outcomes. Many patients with severe pelvic organ prolapse have long vaginal canals and overstretched sacral uterine ligaments, which prevent effective repair using the Shull method. The Kakinuma method (laparoscopic vaginal stump–round ligament fixation) lifts the vaginal stump to an anatomically higher position. This method is an effective treatment method for pelvic organ prolapse, similar to conventional NTR.