The Manchester procedure: A systematic review of recurrence, perioperative measures, and financial cost, and a scoping review of sexual dysfunction, gynecologic cancer, and obstetric outcomes

INTRODUCTION: The Manchester procedure (MP) is increasingly used to treat uterine prolapse. This combined systematic and scoping review aims to comprehensively evaluate clinical outcomes of the MP in comparison with other surgical techniques for uterine prolapse. MATERIAL AND METHODS: PRISMA guidelines were applied for the systematic part of the review and PRISMA-ScR guidelines for the scoping part. PubMed and Embase were searched up to September 30, 2024. The study population comprised women >18 years undergoing MP or other surgical treatments for uterine prolapse. The primary outcome was recurrence of pelvic organ prolapse defined as anatomical or subjective recurrence or reoperation. Secondary outcomes were surgical and operative complications, operative outcome, lower urinary tract symptoms, sexual dysfunction, quality of life and satisfaction, gynecological cancer, obstetric outcome, and financial costs. Data collection was carried out as per PRISMA and PRISMA-ScR guidelines. Quality of the randomized clinical trials was assessed by the Cochrane risk of bias tool and non-randomized studies were assessed using the Newcastle-Ottawa Scale. PROSPERO (no.: CRD42024551520). RESULTS: A total of 19 articles were included: 11 were eligible for the systematic review and 11 for the scoping review, with three articles overlapping. Large cohort studies and one randomized controlled trial demonstrated lower risks of prolapse recurrence and reoperation following the MP compared with alternative surgical approaches. Blood loss, organ injury, and overall surgical complication rates were low across all procedures. Operative time and length of hospital stay were shorter after the MP than after vaginal hysterectomy and comparable to sacrospinous hysteropexy. Cost analyses showed significantly lower costs associated with the MP. Sexual function and dyspareunia outcomes were generally comparable between procedures. Cervical stenosis and risk of cancer after MP is low, with no evidence of increased gynecological cancer incidence or worse prognosis compared with anterior colporrhaphy for cystocele. Due to limited and concerning data on pregnancy outcomes, the MP should be reserved for women who have completed childbearing. CONCLUSION: Despite limited high-quality evidence, the existing literature supports the MP as a clinically effective and cost-efficient uterus-preserving surgical option for uterine prolapse.