Aim: The objective of this study was to evaluate the outcomes of the Manchester procedure (MP) with or without concomitant high uterosacral ligament suspension (HUSLS) for treating uterine prolapse. The primary outcomes were to compare the two methods for differences in perioperative complications and recurrence rates, and to explore whether MP combined with concomitant HUSLS is beneficial in reducing recurrence rates.
Methods: A total of 98 uterine prolapse patients underwent MP or MP-HUSLS during the study period. Demographic data, perioperative, and follow-up outcomes were analyzed retrospectively. Univariate and multivariate cox proportional hazards regression analysis was used to explore the effect of surgical methods on recurrence.
Results: The MP-HUSLS group had a higher degree of apical compartment prolapse before the operation, but the pelvic organ prolapse quantification (POP-Q) values of points Ba and C in the MP-HUSLS group improved significantly compared with the MP group (p < 0.05). The operation time in the MP group was shorter than that in the MP-HUSLS group. There were no differences in baseline characteristics or perioperative complications between the two groups. Twelve patients had subjective recurrence during follow-up, although 20 developed anatomical recurrence. After controlling for confounding factors, the MP group had a higher risk of recurrence in the anterior compartment than the MP-HUSLS (adjusted hazard ratio: 4.191, confidence interval: 1.195-14.701, p = 0.025). There was no significant difference in the recurrence rate of the two groups' total, apical, and posterior compartments.
Conclusion: Compared with MP, MP-HUSLS seems more effective in treating uterine prolapse, with a higher location of the points C and Ba. However, further studies with large samples and long follow-up times need to confirm this result.
Keywords: Manchester procedure; autologous tissue repair; high uterosacral ligament suspension; recurrence; uterine prolapse.
© 2023 Japan Society of Obstetrics and Gynecology.