Treatment outcomes of Manchester procedure versus vaginal hysterectomy for mid-compartment prolapse: A systematic review and meta-analysis

Introduction: To compare the effectiveness and safety of Manchester procedure versus vaginal hysterectomy in the treatment of mid-compartment prolapse in women.

Material and methods: We searched PubMed, Web of Science, Google Scholar, and the Cochrane Library for randomized controlled trials (RCTs), prospective, or retrospective studies comparing the Manchester procedure and vaginal hysterectomy up to July 2024. Primary outcomes included anatomical recurrence, subjective recurrence, overall complication rate, and reoperation. Secondary outcomes included estimated blood loss, operative time, and relevant subgroup analyses. This study has been registered in PROSPERO with the registration number CRD42024575874.

Results: A total of 11 783 cases from 1 RCT, 1 prospective study, and 9 retrospective studies were included. For the primary outcomes, the Manchester procedure demonstrated significantly lower subjective recurrence rates (risk ratio [RR] = 0.85; 95% confidence interval [CI]: 0.73-0.98; I² = 0%; p = 0.03) and reoperation rates (RR = 0.62; 95% CI: 0.43-0.89; I² = 64%; p = 0.009) compared with vaginal hysterectomy, with no significant difference in anatomical recurrence rates (RR = 0.84; 95% CI: 0.58-1.21; I² = 54%; p = 0.34) and overall complication rates (RR = 0.89; 95% CI: 0.79-1.00; I² = 0%; p = 0.06) between the two groups. Secondary outcomes indicated that the Manchester procedure had a significantly shorter operative time and less estimated blood loss (p < 0.05). Subgroup analysis indicated that the Manchester procedure was associated with lower short-term (1-3 years) subjective recurrence rates (RR = 0.87; 95% CI: 0.78-0.98; I² = 0%; p = 0.02) and reoperation rates (RR = 0.71; 95% CI: 0.55-0.92; I² = 0%; p = 0.008). No significant differences were found between the two groups in terms of short-term anatomical recurrence rates or in mid- to long-term (>3 years) subjective recurrence rates, anatomical recurrence rates, and reoperation rates (p > 0.05).

Conclusions: Overall, the rates of anatomical recurrence and overall complications for Manchester procedure and vaginal hysterectomy are similar. Manchester procedure appears to have a lower subjective recurrence and reoperation rate in the short term, but this advantage was not observed in mid- to long-term follow-up. Further high-quality prospective studies are needed to confirm these findings.