Yonsei Med J.  2019 Nov;60(11):1074-1080. 10.3349/ymj.2019.60.11.1074.

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

• Park YJ
• Kong MK
• Lee J
• Kim EH
• Bai SW

• KMID: 2460225
• DOI: http://doi.org/10.3349/ymj.2019.60.11.1074

Abstract

PURPOSE
Descent 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 METHODS
Medical 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.
RESULTS
During 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.
CONCLUSION
The 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.

Keyword

Clinical outcome; Manchester operation; true cervical elongation; uterine prolapse

MeSH Terms

Body Mass Index
Female
Humans
Hysterectomy, Vaginal
Medical Records
Parity
Pelvic Organ Prolapse
Propensity Score
Recurrence
Risk Factors
Uterine Prolapse*
Uterus

Figure

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  Fig. 1 Flow chart. POP-Q, Pelvic Organ Prolapse Quantification; APD, anteroposterior diameter; TVS, transvaginal ultrasonography; VH, vaginal hysterectomy.

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