The Manchester-Fothergill procedure versus vaginal hysterectomy
with uterosacral ligament suspension: a matched historical cohort study
Cæcilie Krogsgaard Tolstrup
Karen Ruben Husby
Tine Iskov Kopp
Petra Hall Viborg
Ulrik Schiøler Kesmodel
Received: 11 August 2017 / Accepted: 6 November 2017 / Published online: 29 December 2017
The International Urogynecological Association 2017
Introduction and hypothesis This study compares vaginal hysterectomy with uterosacral ligament suspension (VH) with the
Manchester-Fothergill procedure (MP) for treating pelvic organ prolapse (POP) in the apical compartment.
Methods Our matched historical cohort study is based on data from four Danish databases and the corresponding electronic
medical records. Patients with POP surgically treated with VH (n = 295) or the MP (n = 295) in between 2010 and 2014 were
matched for age and preoperative POP stage in the apical compartment. The main outcome was recurrent or de novo POP in any
compartment. Secondary outcomes were recurrent or de novo POP in each compartment and complications.
Results The risk of recurrent or de novo POP in any compartment was higher after VH (18.3%) compared with the MP (7.8%)
(Hazard ratio, HR = 2.5, 95% confidence interval (CI): 1.3–4.8). Recurrence in the apical compartment occurred in 5.1% after
VH vs. 0.3% after the MP (hazard ratio (HR) = 10.0, 95% confidence interval (CI) 1.3–78.1). In the anterior compartment, rates
of recurrent or de novo POP were 11.2% after VH vs. 4.1% after the MP (HR = 3.5, 95% CI 1.4–8.7) and in the posterior
compartment 12.9% vs. 4.7% (HR = 2.6, 95% CI 1.3–5.4), respectively. There were more perioperative complications (2.7 vs.
0%, p = 0.007) and postoperative intra-abdominal bleeding (2 vs. 0%, p = 0.03) after VH.
Conclusions This study shows that the MP is superior to VH; if there is no other indication for hysterectomy, the MP should be
preferred to VH for surgical treatment of POP in the apical compartment.
Pelvic organ prolapse
Uterine prolapse is a common condition for which no cur-
rent standard for surgical repair exists. Anatomical uterine
prolapse affects 14.2% of postmenopausal women , and
~175,000 apical-compartment prolapse surgeries are per-
formed annually in the USA . The aging population in
many developed countries has caused an increase in this
evidence, the surgical strategy for uterine prolapse repair
varies greatly. Vaginal hysterectomy (VH) has been the
most common surgical method for years and remains the
preferred procedure worldwide [4–6]. New surgical proce-
dures for treating prolapse in the apical compartment have
been developed in recent years, and in some countries,
mesh-based procedures and robotic surgery have gained
popularity. Currently, many patients demand uterus-
preserving procedures [7, 8], and recent studies have shown
less morbidity and shorter hospitalization associated to
uterus-preserving procedures compared with VH [9, 10].
The Manchester-Fothergill procedure (MP)—auterus-
preserving technique performed for more than a centu-
ry—has proven safe and durable . Even so, studies
comparing other surgical procedures to the MP are scarce,
and only one small, randomized controlled trial (RCT)
comparing VH to the MP exists . In general, the
existing literature is in favor of the MP .
The abstract was presented at the NUGA bi-annual meeting, Reykjavik,
Iceland, April 2017, and the 2017 IUGA Scientific Meeting, Vancouver,
* Cæcilie Krogsgaard Tolstrup
Department of Obstetrics and Gynecology, Herlev and Gentofte
University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
University of Copenhagen, Copenhagen, Denmark
Research Centre for Prevention and Health, Capital Region of
Denmark, Copenhagen, Denmark
International Urogynecology Journal (2018) 29:431–440