title: The Manchester procedure versus vaginal hysterectomy in the treatment of uterine prolapse: a review.
abstract: OBJECTIVE
  Uterine prolapse is a common health problem and the number of surgical procedures is increasing. No consensus regarding the surgical strategy for repair of uterine prolapse exists. Vaginal hysterectomy (VH) is the preferred surgical procedure worldwide, but uterus-preserving alternatives including the Manchester procedure (MP) are available. The objective was to evaluate if VH and the MP are equally efficient treatments for uterine prolapse with regard to anatomical and symptomatic outcome, quality of life score, functional outcome, re-operation and conservative re-intervention rate, complications and operative outcomes.
  
  
  METHODS
  We systematically searched Embase, PubMed, the Cochrane databases, Clinicaltrials and Clinical trials register using the MeSh terms "uterine prolapse", "uterus prolapse", "vaginal prolapse" "pelvic organ prolapse", "prolapsed uterus", "Manchester procedure" and "vaginal hysterectomy". No limitations regarding language, study design or methodology were applied. In total, nine studies published from 1966 to 2014 comparing the MP to VH were included.
  
  
  RESULTS
  The anatomical recurrence rate for the middle compartment was 4-7 % after VH, whereas recurrence was very rare after the MP. The re-operation rate because of symptomatic recurrence was higher after VH (9-13.1 %) compared with MP (3.3-9.5 %) and more patients needed conservative re-intervention (14-15 %) than after MP (10-11 %). After VH, postoperative bleeding and blood loss tended to be greater, bladder lesions and infections more frequent and the operating time longer.
  
  
  CONCLUSIONS
  This review is in favour of the MP, which seems to be an efficient and safe treatment for uterine prolapse. We suggest that the MP might be considered a durable alternative to VH in uterine prolapse repair.
authors.affiliation: Department of Obstetrics and Gynecology, Herlev & Gentofte University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark. caecilie.krogsgaard.tolstrup@regionh.dk.
authors.forename: Cæcilie Krogsgaard
authors.initials: CK
authors.lastname: Tolstrup
authors.affiliation: Department of Obstetrics and Gynecology, Herlev & Gentofte University Hospital and Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Lose
authors.affiliation: Department of Obstetrics and Gynecology, Herlev & Gentofte University Hospital and Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Klarskov
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods*; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000473:pathology / Q000601:surgery*; D014599:Uterus / Q000601:surgery*
keywords: Efficacy; Manchester procedure; Safety; Surgery; Uterine prolapse; Vaginal hysterectomy