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3 - THE MANCHESTER-FOTHERGILL PROCEDURE VERSUS VAGINAL HYSTERECTOMY IN THE TREATMENT OF UTERINE PROLAPSE: A MATCHED COHORT STUDY

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THE MANCHESTER-FOTHERGILL PROCEDUREVERSUS VAGINAL HYSTERECTOMY IN THE TREATMENT OF UTERINE PROLAPSE: AMATCHED COHORT STUDY

C. KROGSGAARD TOLSTRUP 1, K.HUSBY 1, G. LOSE 1, T. I. KOPP 2, P.HALL VIBORG 2, U. S. KESMODEL 1, N.KLARSKOV1;
1Department of Obstetricsand Gynecology, Herlev & Gentofte Univ. Hosp., Herlev, Denmark,2Research Centre for Prevention and Health, Capital Regionof Denmark, Glostrup, Denmark.

Introduction: Uterine prolapseis a common condition for which no current standard for surgicalrepair exists. The choice of surgery varies greatly internationallywith vaginal hysterectomy (VH) being the preferred procedureworldwide. Currently uterus-preserving procedures are in demand bypatients and recent studies have shown less morbidity and shorterhospitalization associated with uterus-preserving procedures comparedto VH (1,2).
Objective: The aim of the study was to comparethe outcomes of the Manchester-Fothergill procedure (MP) with theoutcomes of VH in treatment of uterine prolapse.
Methods:Based on data from The Danish Urogynaecological Database, the DanishHysterectomy and Hysteroscopy Database, the Danish AnaesthesiaDatabase, the Danish National Pathology Registry and Data Bank andthe corresponding medical records, we conducted a matched historicalcohort study. Women who underwent VH or MP in one of four publichospitals in the Capital Region of Denmark in 2010-2014 were eligiblefor matching. The patients were matched according to the preoperativeprolapse stage in the middle compartment and according to age. The VHand MP could be combined with an anterior and/or posteriorcolporrhaphy. Outcomes were recurrence, de novo pelvic organ prolapse(POP) in any compartment and complications. Recurrence was defined asPOP in a compartment with previous surgery and de novo POP wasdefined as POP in a compartment without previous surgery. POP wasdefined as one or more of the following: A) POP treated with pessaryor surgery. B) POP-Q stage ≥ 2 with POP symptoms. C) POP-Q stage ≥3 independent of POP symptoms.
Results: In total 295 pairswere included and the mean follow up time was 51 months in theVH-group and 48 months in the MP-group (p=0.02). No significantdifferences were found in the baseline age, BMI, ASA score,deliveries, POP-Q stage, previous POP surgery, and surgeon experiencelevel between the two groups. Table 1 summarizes recurrence and denovo POP development after the two operations; there weresignificantly more recurrences after VH in all three compartments andsignificantly more patients had de novo POP in the anterior andposterior compartment after VH compared to after MP. Figure 1 showsrecurrence/ de novo POP development in any compartment as a functionof time for the two operations. More perioperative complications(2.7% vs. 0%, p=0.007a) were related to VH and morepostoperative intraabdominal bleedings requiring surgery were seenafter VH (2% vs. 0%, p=0.03a).
Conclusions: Morepatients develop recurrence and de novo POP in the anterior, middleand posterior compartment after VH compared to after MP. There are inaddition more perioperative complications and severe postoperativebleedings after VH. Based on these findings the MPshould be the first choice in surgical treatment of uterine prolapsewhen no other indication for removal of the uterus is present.
aVHvs. MP. bFischer's exact test.
References: 1)Int Urogynecol J Pelvic Floor Dysfunct 2004;15(4):286-92 2) IntUrogynecol J 2017; 28(1):33-40

Table1 Recurrence/de novo POP

Recurrence/denovo POP

MP(n)

VH(n)

Pvalue

Anycompartment, n (%)

23(7.8) (295)

54(18.3) (295)

0.0002b

Middlecompartment, n (%)

1(0.3) (295)

15(5.1) (295)

0.0004b

HR(95% CI)a

1.00(ref)

10.0(1.28-78.11)


Anteriorcompartment, n (%)

12(4.1) (295)

33(11.2) (295)

0.002b

HR(95% CI)a

1.00(ref)

3.50(1.41-8.67)


Recurrence,n (%)

11(4.1) (266)

22(8.3) (264)

0.05b

Denovo POP, n (%)

1(3.4) (29)

11(35.5) (31)

0.002b

Posteriorcompartment, n (%)

14(4.7) (295)

38(12.9) (295)

0.0007b

HR(95% CI)a

1.00(ref)

2.60(1.25-5.39)


Recurrence,n (%)

1(1.4) (73)

9(8.5) (106)

0.05b

Denovo POP, n (%)

13(5.9) (222)

29(15.3) (189)

0.02b