Laparoscopic Non-Mesh Cerclage Pectopexy for Pelvic Organ Prolapse

The laparoscopic non-mesh cerclage pectopexy is developed to treat pelvic organ prolapse eliminating mesh erosion complications. LNMCP avoids using synthetic mesh, thereby eliminating any risk of related complications and reducing the medical expenses for the patients. To begin, expose the iliopectineal ligament near the landmarks, including the round ligament and the obliterated umbilical artery.

Make an eight-centimeter-long incision in the peritoneum along the inner edge of the round ligament toward the pelvic wall until the iliopectineal ligament is reached. Locate the posterior aspect of the iliopectineal ligament immediately below the external iliac vein. Then, perform cervical cerclage by suturing, ligating, and attaching a round ligament to the cervical stump in the uterine isthmus using a permanent suture beginning on the right side and moving in the counterclockwise direction.

Perform peripheral movements with the needle around the cervix to complete one round until the starting position. Upon completing the cervical cerclage, tighten and suture the stitch. Embed the suture in the round ligament until the iliopectineal ligament.

Insert the suture through the iliopectineal ligament to ensure tension-free anchoring and perform re-peritonealization with an absorbable suture. LNMCPP was performed successfully in 16 patients. The calculated mean age was 58.5 years, the mean estimated blood loss was 73.1 milliliters, and the mean operation time was 67.8 minutes.

All women visited the hospital for follow-up after a mean duration of 6.6 months. An objective success rate of 100%was observed until the last follow-up, while the subjective success rate was 93.8%Permanent cervical cerclage sutures are embedded in the round ligament until the iliopectineal ligament. The suturing of the iliopectineal ligament is achieved from cervical suspension.