Women’s well-being after Manchester procedure for pelvic reconstruction with uterine preservation: a follow-up study

Liebergall-Wischnitzer, Michal; Ben‐Meir, Assaf; Sarid, Orly; Cwikel, Julie; Lavy, Yuval

doi:10.1007/s00404-011-2195-0

Cited by 11 publications

(10 citation statements)

References 26 publications

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“…In a review comparing uterine preservation with hysterectomy, Kapoor et al [19] cautioned that the risk of cancer is the most significant disadvantage [20]. Studies comparing vaginal hysterectomy with uterine-sparing prolapse surgery have not demonstrated significant differences in objective or subjective cure rates, and there is no recognized standard procedure to suspend the uterus [14,16,17,19].…”

Section: Discussionmentioning

confidence: 99%

Uterus-Sparing Surgery: Outcomes of Transvaginal Uterosacral Ligament Hysteropexy

Aserlind

Garcia

2021

Journal of Minimally Invasive Gynecology

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Study Objective: Recently, there has been a paradigm shift toward uterine conservation during the surgical management of pelvic organ prolapse (POP), specifically uterine prolapse. There are few reports on transvaginal uterosacral ligament hysteropexy (TULH). This study aimed to describe our surgical technique and outcomes. Design: Retrospective review and description of surgical technique. Anatomic outcome has been reported using the POP quantification system. Complications were segregated. A comparison of parametric continuous variables was performed using paired t test. Categoric variables were evaluated using the Pearson x 2 test and the Fisher exact test. A p-value <.05 was considered significant. Setting: Teaching hospital. Patients: Forty patients who underwent TULH from 2009 to 2017. Interventions: TULH. Measurements and Main Results: A total of 40 patients met the inclusion criteria. Of these, 56.1% had preoperative stage 3 prolapse. The median operative time was 116 minutes. The mean estimated blood loss was 158.5 mL. Transient ureteral obstruction occurred in 2 patients. The mean follow-up time was 17.2 months, and all patients had significant improvement of prolapse (p <.001). There was also an improvement in urinary incontinence and bladder storage symptoms (p <.001). None of the patients were reoperated on for recurrent POP. Conclusion: TULH is an effective uterus-preserving surgical alternative for the treatment of uterovaginal prolapse and provides good apical support. It is also associated with a low short-term recurrence and incidence of reoperation. TULH is a viable option for suitable patients with uterovaginal prolapse who desire uterine conservation.

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Section: Discussionmentioning

confidence: 99%

Uterus-Sparing Surgery: Outcomes of Transvaginal Uterosacral Ligament Hysteropexy

Aserlind

Garcia

2021

Journal of Minimally Invasive Gynecology

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“…In addition, in a recent study, cervical length measured using the POP-Q system was more related to anatomical cervical length than that reported in an imaging study 12. Moreover, measuring D point in the POP-Q system was necessary to differentiate between true cervical elongation and uterine descent 131415…”

Section: Discussionmentioning

confidence: 92%

Manchester Operation: An Effective Treatment for Uterine Prolapse Caused by True Cervical Elongation

et al. 2019

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PurposeDescent of the uterus is a major etiology of uterine prolapse. However, true cervical elongation can cause uterine prolapse without uterine descent. The aim of study was to investigate the clinical outcomes of Manchester operation in patients with uterine prolapse caused by “true cervical elongation,” compared with vaginal hysterectomy (VH).Materials and MethodsMedical records of patients who underwent Manchester operation or VH from 2006 to 2015 were reviewed. True cervical elongation was defined on the basis of C point of the Pelvic Organ Prolapse Quantification (POP-Q) system ≥0 and D point ≤−4, as well as estimated cervical length of ≥5 cm. The primary outcome was recurrence of pelvic organ prolapse (POP) evaluated by POP-Q system. The outcomes of two groups were compared after propensity score matching, for age, parity, and preoperative POP-Q stage.ResultsDuring the study period, 23 patients underwent Manchester operation and 374 patients underwent VH. The recurrence rate of POP (p=0.317) and complication rate were not statistically significant different between the two study groups. Manchester operation exhibited shorter operation time than VH (p=0.033). In subgroup analysis (POP-Q stage III), body mass index [odds ratio (OR)=1.74; 95% confidence interval (CI), 1.08–2.81] and not having concurrent anterior colporrhaphy (OR for concurrent anterior colporrhaphy, 0.06; 95% CI, 0.01–0.75) were identified as significant risk factors for recurrence of POP.ConclusionThe Manchester operation technique seems to be an effective and safe alternative procedure for the treatment of uterine prolapse caused by true cervical elongation, compared with VH.

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“…The uterosacral-Mackenrodt remnants are reattached to the cervical stump to strengthen it with the help of a Sturmdorff suture. In a longitudinal study, it was concluded that reconstructive surgeries for women with cervical elongation, with or without associated POP, was well received in terms of patient's satisfaction, improved quality of life and sexual function [3] . In a 3-year follow-up in Penang Hospital, Malaysia, the anatomical recurrence rate following vaginal hysterectomy was 4-7%, whereas recurrence was very rare after the Manchester procedure [4] .…”

Section: Discussionmentioning

confidence: 99%

Manchester repair revisited during the COVID surge: exploring its advantages over conventional restorative surgeries

Sarkar¹,

Sharma²,

Jindal³

et al. 2021

Int. J. Clin. Obstet. Gynaecol.

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Cervical descent is a major etiology of uterine prolapse. However, true elongation of cervix can cause uterine prolapse without its descent. Most patients find it difficult to come for follow-up visits to hospitals during the ongoing COVID surge. So, they prefer definitive surgeries. Moreover, young patients with prolapse want fertility preservation and subsequent pregnancies. So, we hereby report a case of Manchester operation being performed in a female with cervical elongation who was keen on uterus preservation, thereby analyzing the advantages of this procedure over conventional restorative surgeries for pelvic organ prolapse.

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Women’s well-being after Manchester procedure for pelvic reconstruction with uterine preservation: a follow-up study

Abstract: The modified Manchester procedure including reconstructive surgery for women with cervix elongation, with or without POP, prevented recurrent uterine prolapse and was well received in terms of patient's satisfaction, quality of life, and sexual function.

Cited by 11 publications

References 26 publications

Uterus-Sparing Surgery: Outcomes of Transvaginal Uterosacral Ligament Hysteropexy

Uterus-Sparing Surgery: Outcomes of Transvaginal Uterosacral Ligament Hysteropexy

Manchester Operation: An Effective Treatment for Uterine Prolapse Caused by True Cervical Elongation

Manchester repair revisited during the COVID surge: exploring its advantages over conventional restorative surgeries

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