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International Urogynecology Journal
Published in: International Urogynecology Journal 3/2018

01-03-2018 | Original Article

The Manchester-Fothergill procedure versus vaginal hysterectomy with uterosacral ligament suspension: a matched historical cohort study

Authors: Cæcilie Krogsgaard Tolstrup, Karen Ruben Husby, Gunnar Lose, Tine Iskov Kopp, Petra Hall Viborg, Ulrik Schiøler Kesmodel, Niels Klarskov

Published in: International Urogynecology Journal | Issue 3/2018

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Abstract

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.
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Metadata
Title
The Manchester-Fothergill procedure versus vaginal hysterectomy with uterosacral ligament suspension: a matched historical cohort study
Authors
Cæcilie Krogsgaard Tolstrup
Karen Ruben Husby
Gunnar Lose
Tine Iskov Kopp
Petra Hall Viborg
Ulrik Schiøler Kesmodel
Niels Klarskov
Publication date
01-03-2018
Publisher
Springer London
Published in
International Urogynecology Journal / Issue 3/2018
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-017-3519-9

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