Uterine prolapse affects millions of women globally, yet the optimal surgical approach remains contested. A comprehensive evidence synthesis now positions the Manchester procedure — a cervix-amputating, ligament-shortening repair developed over a century ago — as a competitive frontrunner against newer techniques, with implications for how gynecologic surgeons select among available options.
This dual systematic and scoping review, registered on PROSPERO and conducted to September 2024, analyzed 19 articles drawn from PubMed and Embase, including one randomized controlled trial and several large cohort studies. The Manchester procedure demonstrated lower rates of anatomical and subjective prolapse recurrence as well as reduced reoperation rates compared with alternative surgical techniques for uterine prolapse. Quality assessment employed the Cochrane risk-of-bias tool for randomized trials and the Newcastle-Ottawa Scale for observational data, lending methodological rigor to what is an inherently heterogeneous evidence base. Secondary outcomes including surgical complications, lower urinary tract symptoms, sexual function, quality of life, gynecologic cancer risk, obstetric outcomes in women who subsequently conceived, and financial costs were also evaluated through the scoping component.
What makes this review particularly valuable is its breadth: long-standing clinical concerns about the Manchester procedure — including whether cervical amputation elevates cervical cancer risk or compromises future fertility — are addressed alongside hard efficacy endpoints. These questions have historically deterred uptake despite the technique's longevity. The evidence base remains limited, however; 19 articles is a modest corpus for a systematic review, and the single RCT constrains causal inference. Heterogeneity across outcome definitions, especially for prolapse recurrence, is a perennial problem in pelvic floor surgery research. Overall, the review is best characterized as confirmatory and consolidating rather than paradigm-shifting — it strengthens the case for the Manchester procedure as a uterus-preserving option for appropriately selected women, but multicenter RCTs with standardized outcome measures are still needed before definitive clinical algorithms can be drawn.