Cervical amputation and fixation
After exposing the cervix and dissecting the vaginal mucosa around it, the surgeon separates the bladder, using the Manchester technique, crosses and shortens the cardinal ligaments, then amputates the elongated part of the cervix (usually 2–4 cm) in a wedge-shaped fashion and forms a pharynx by suturing the vaginal mucosa to the cervical canal (Sturmdorff sutures); the shortened ligaments are sutured to the anterior surface of the cervix, raising the uterus. For cystocele, anterior colporrhaphy is performed simultaneously. The result is a cervix of normal length, elimination of prolapse, preservation of the uterus and menstrual function. Histology of the removed neck is required.
Indications
- elongation (lengthening) of the cervix with its protrusion beyond the genital slit with a normally positioned body of the uterus;
- uterine prolapse of I–II degree due to an elongated cervix in women wishing to preserve the uterus (Manchester operation);
- cervical hypertrophy with chronic inflammation, deformation, scars after childbirth;
- combination with prolapse of the vaginal walls - together with colporrhaphy.
The essence of the operation
Elongation is the lengthening of the cervix, in which the cervix descends or protrudes, rubs, becomes inflamed and interferes with sexual activity, although the body of the uterus remains in place. Amputation of the excess part of the cervix restores normal length; when combined with prolapse, the ligaments are shortened and fixed (Manchester operation) - this is an organ-preserving method for women who do not want a hysterectomy. The operation is performed through the vagina without incisions, and the removed tissue is examined histologically. After the operation, menstruation continues; pregnancy is possible, but requires monitoring of the cervix.
