Does Round-Ligament-Based Non-Mesh Pectopexy Provide Durable and Effective Apical Support After Total Laparoscopic Hysterectomy?

Objective: To assess the anatomical and clinical outcomes of a novel, mesh-free cerclage pectopexy technique that uses the round ligament for apical support following total laparoscopic hysterectomy in women with stage II uterine prolapse. Methods: This retrospective observational study included 120 women with stage II uterine prolapse who underwent total laparoscopic hysterectomy followed by laparoscopic non-mesh pectopexy between October 2023 and August 2024. In this procedure, the distal portion of each round ligament was fixed to the pectineal ligament using Ethibond sutures. Multiple plicating stitches were then placed to reinforce the ligament’s tensile strength, creating a biological suspension bridge between the pectineal ligament and the vaginal cuff. All patients were examined preoperatively and at 1, 3, 6, and 12 months postoperatively using the POP-Q system. Anatomical success was defined as an apical stage ≤ I at 12 months. Results: At the twelve-month follow-up, anatomical success was achieved in 95 percent of patients, with six cases of apical recurrence. POP-Q measurements showed significant improvement from baseline, and total vaginal length was preserved. Functional outcomes, including postoperative pain and dyspareunia, were favorable. Early complications were uncommon, and no intraoperative or mesh-related complications occurred. Conclusion: Round-ligament-based non-mesh cerclage pectopexy provides reliable apical support with minimal surgical morbidity following total laparoscopic hysterectomy. This technique appears to provide effective apical support with low surgical morbidity while avoiding synthetic mesh. Preservation of vaginal length and favorable short-term clinical outcomes were observed; however, longer-term comparative studies are required. Future prospective studies combining this procedure with other minimally invasive suspension techniques, such as McCall culdoplasty or uterosacral plication, may broaden its applicability to more advanced prolapse cases.