Hysteropexy inferior to Manchester Procedure for Uterine Descent: JAMA

The findings published in the Journal of American Medical Association found that sacrospinous hysteropexy demonstrates inferiority compared to the Manchester procedure.

Pelvic organ prolapse, a condition in which the uterus or other organs descend into the vaginal canal, often necessitates surgical intervention. Sacrospinous hysteropexy, the prevailing uterus-preserving approach, has dominated the field. However, the older Manchester procedure still holds ground as an alternative technique. So, Enklaar Rosa and team conducted this randomized clinical trial across 26 hospitals in the Netherlands on the comparative effectiveness of two popular surgical techniques: sacrospinous hysteropexy and the Manchester procedure.

This landmark study, which involved 434 adult patients undergoing their first surgical treatment for uterine descent that did not protrude beyond the hymen, sought to address this information gap. Participants were randomly assigned to undergo either sacrospinous hysteropexy or the Manchester procedure. The primary measure of success was a composite outcome that included factors such as absence of pelvic organ prolapse beyond the hymen, absence of bothersome bulge symptoms, and no need for prolapse retreatment within two years post-operation.

The results, involving 393 participants, were noteworthy. Among those who underwent sacrospinous hysteropexy, 77.0% achieved the defined composite success outcome. In contrast, the Manchester procedure boasted a higher success rate of 87.3%. The noninferiority criterion of a 9% margin was not met by sacrospinous hysteropexy, indicating its inferiority to the Manchester procedure.

Although the results indicate a superiority of the Manchester procedure in terms of the composite outcome, it's important to note that perioperative outcomes and patient-reported outcomes did not significantly differ between the two groups during the two-year follow-up period. The study not only provides valuable insights for clinicians but also empowers women to make informed decisions about their health.

Source:

Enklaar, R. A., Schulten, S. F. M., van Eijndhoven, H. W. F., Weemhoff, M., van Leijsen, S. A. L., van der Weide, M. C., van Bavel, J., Adang, E. M. M., & Kluivers, K. B. (2023). Manchester procedure vs sacrospinous hysteropexy for treatment of uterine descent: A randomized clinical trial. JAMA: The Journal of the American Medical Association, 330(7), 626–635. https://doi.org/10.1001/jama.2023.13140