title: The Manchester repair: an instructional video.
abstract: OBJECTIVE
  The Manchester repair, developed in the UK by Donald, described in 1908, and later modified by Fothergill, is a well-studied and proven surgical treatment for uterovaginal prolapse when uterine preservation is desired. This operation is currently not widely performed in parts of the world (USA) but is becoming increasing popular in Europe. The objective of this video is to demonstrate our surgical technique and recommendations for successful completion of the procedure.
  
  
  METHODS
  This patient is a 39-year-old woman with two previous vaginal deliveries who presented with a 1-year history of vaginal protrusion. She had no urinary or bowel symptoms. On examination, she had a grade 2 cystocele and uterine descent. She desired surgical management of her uterovaginal prolapse but wished to retain her uterus. The procedure involves mobilizing the vagina and bladder off the cervix and uterosacral cardinal ligament complex anteriorly and laterally. The cervix is then amputated. The ligaments are clamped, cut, and ligated and attached to the anterior cervical remnant with an overlapping suture. This pulls the cervix backward into the pelvis and results in anteversion of the uterus. A posterior and then anterior Sturmdorf suture is used to reconstruct the cervix by covering the amputated cervix with vaginal mucosa.
  
  
  CONCLUSIONS
  The Manchester repair is an operation worth considering in patients where preservation of the uterus is desired. It uses native tissue and has a low complication rate and good long-term results.
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, 155 Studley Road, Heidelberg, VIC, 3084, Australia. walshcarly@yahoo.com.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Walsh
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, 155 Studley Road, Heidelberg, VIC, 3084, Australia.
authors.forename: Lin L
authors.initials: LL
authors.lastname: Ow
authors.affiliation: Govt Kasthurbha Gandhi Hospital, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: N
authors.initials: N
authors.lastname: Rajamaheswari
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, 155 Studley Road, Heidelberg, VIC, 3084, Australia.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Dwyer
mesh_terms: D000328:Adult; D052858:Cystocele / Q000209:etiology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008022:Ligaments / Q000601:surgery; D059351:Organ Sparing Treatments / Q000379:methods*; D017773:Pelvic Floor / Q000601:surgery; D013536:Suture Techniques; D001743:Urinary Bladder / Q000601:surgery; D014596:Uterine Prolapse / Q000209:etiology / Q000601:surgery*; D014599:Uterus / Q000601:surgery; D014621:Vagina / Q000601:surgery
keywords: Cervical elongation; Cystocoele; Manchester repair; Ureteric injury; Uterine preservation