TY - JOUR
T1 - The Manchester-Fothergill procedure versus vaginal hysterectomy with uterosacral ligament suspension
T2 - a matched historical cohort study
AU - Tolstrup, Cæcilie Krogsgaard
AU - Husby, Karen Ruben
AU - Lose, Gunnar
AU - Kopp, Tine Iskov
AU - Viborg, Petra Hall
AU - Kesmodel, Ulrik Schiøler
AU - Klarskov, Niels
PY - 2018
Y1 - 2018
N2 - 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.
AB - 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.
KW - Manchester-Fothergill procedure
KW - Pelvic organ prolapse
KW - Recurrence
KW - Vaginal hysterectomy
U2 - 10.1007/s00192-017-3519-9
DO - 10.1007/s00192-017-3519-9
M3 - Journal article
C2 - 29288346
AN - SCOPUS:85039751235
SN - 0937-3462
VL - 29
SP - 431
EP - 440
JO - International Urogynecology Journal
JF - International Urogynecology Journal
IS - 3
ER -