Three stages in one operation
The Manchester operation combines three components: anterior colporrhaphy to correct prolapse of the anterior vaginal wall and cystocele, amputation of the elongated (elongated) cervix with shortening and fixation of the cardinal ligaments, and colpoperineoplasty - restoration of the posterior wall of the vagina and perineum with rapprochement of the levators. This combination allows you to simultaneously solve the problem of omission in all directions.
The key advantage over removal of the uterus: the organ is preserved, which is important for women who do not want to part with the uterus. The limitation is significant - after the operation, the cervix is shortened, and although pregnancy is technically possible, pregnancy is associated with a high risk. Therefore, the operation is performed on women who have completed childbearing.
When is reconstructive surgery needed?
Childbirth, especially with perineal ruptures and a large fetus, and age-related changes lead to stretching and damage to the muscles and ligaments of the pelvic floor. Prolapse of the walls of the vagina, uterus and bladder develops, a feeling of a foreign body, urinary incontinence, impaired bowel movements and discomfort in sexual life appear.
Conservative methods - Kegel exercises, pessaries - are effective in the early stages. In case of pronounced prolapse and formed defects, the anatomy can only be restored surgically.
Principles of reconstruction
- restoration of anatomy using the patient’s own tissues
- bringing the levator muscles together to form support for the pelvic floor
- excision of scar tissue that is unable to bear the load
- if necessary, a combination of several stages in one operation
Recovery
The key condition for success is adherence to the regime: sexual rest for 6–8 weeks, avoiding heavy lifting and preventing constipation. An increase in intra-abdominal pressure in the early period is the main cause of suture dehiscence and relapse of prolapse.