The modified Manchester operation Ingrid van Zon-Rabelink, Ellen Everhardt, Julien Dony Reconstructive surgery in pelvic organ prolapse with preservation of the uterus

Uterosacral ligament plication; Mc Call suture

Retrospective cohort study patients Mean age 61 years Mean time followup 21 months 115 questionaire 64 % 123 POP-Q 69%

Pre- and postoperative POP-Q results prolapseAnterior preop Anterior postop Apical preop Apical postop Posterior preop Posterior postop 02.2 %48.4 %1.7 %82.9 %42.0 %63.6 % 114 %32.0 %22.7 %14.6 %38.1 %25.6 % %19.7 %61.4 %0.8 %15.9 %9.1 % %-13.1 %1.6 %4.0 %1.7 % %---

Patient satisfaction (very) satisfied 82 % moderate satisfied-dissatisfied18 % ◦ Recurrence 5 % recommend procedure91 % recovery postop < 3 months 96 % ◦ recovery postop < 4 weeks 50 %

Concluding message The modified Manchester operation is a safe procedure for treating pelvic organ prolapse with a low number of recurrent prolapse and a high level of patient satisfaction after surgery.

The Manchester Nine 1Hydrodissection 2Cervical circumcision 3Cuff preparation 4Bladder displacement 5Uterosacral ligament plication Mc Call suture 6Cardinal ligament plication 7Colporrhaphia anterior 8Cervical amputation-Sturmdorf suture 9Colporrhaphia posterior