Manchester repair ('fothergill's operation') revisited

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 3 – C O R E S U R G I C A L S K I L L S

Manchester Repair ('Fothergill's Operation') Revisited Dharmasena D et al. Manchester repair ('Fothergill's operation') revisited. TOG 2021;23:148–153. doi:10.1111/tog.12724

14% 18.3% vs 7.8% 1-0 Vicryl POSTMENOPAUSAL WOMEN WITH UTERINE RECURRENT/DE NOVO POP: VH VS SUTURE SECURING CARDINAL PROLAPSE MANCHESTER (TOLSTRUP 2018) LIGAMENT/UTERINE ARTERY

DO N' T-M IS S FA C TS

  1. Manchester repair = cervical amputation + anterior approximation of cardinal ligaments (Donald 1908, modified by Fothergill); for 2nd/3rd-degree prolapse in women wishing to retain the uterus

  2. Tolstrup 2018 matched cohort: recurrent/de novo POP 7.8% (Manchester) vs 18.3% (VH) (95% CI 1.3–4.8); complications 0% vs 2.7% (p=0.007)

  3. Cervix dilated to Hegar H8; skeletonise only to uterovesical fold – do not breach peritoneum

  4. Sutures: cardinal ligament/uterine artery & Sturmdorf – 1-0 Vicryl; Fothergill suture – 0-0 PDS; pubocervical fascia – 2-0 PDS; vaginal margins – 2-0 Vicryl

  5. Contraindications: abnormal/postmenopausal bleeding, endometrial pathology, cervical dysplasia, tamoxifen, HNPCC, BRCA1/2, poor follow-up compliance

  6. Not suitable for incomplete families – limited pregnancy data show ↑preterm labour/PPROM risk; consider cerclage

  7. Late complications: cervical stenosis → haematometra/pyometra; cervical incompetence; dyspareunia

  8. Not in current Advanced Training Skills Modules/subspecialty curriculum; upload outcomes to BSUG Audit database

EVIDENCE AT A GLANCE

Manchester repair: less recurrence, fewer complications, less bleeding vs VH (Tolstrup 2016 & 2018)

Limited/small-series evidence only for fertility & pregnancy outcomes

ABBREVIATION KEY

VH — vaginal hysterectomy PPROM — preterm prelabour rupture of membranes

POP — pelvic organ prolapse HNPCC — hereditary nonpolyposis colonic cancer

BSUG — British Society of Urogynaecologists PDS — polydioxanone suture

NICE — National Institute for Health and Care Excellence Vicryl — polyglactin 910 suture

MDT — multidisciplinary team CI — confidence interval

RT — radical trachelectomy

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — Dharmasena D et al. Manchester repair ('Fothergill's operation') revisited. TOG 2021;23:148–153. doi:10.1111/tog.12724

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