1. The modified Manchester operation Ingrid van Zon-Rabelink, Ellen Everhardt, Julien Dony Reconstructive surgery in pelvic organ prolapse with preservation of the uterus

2. Uterosacral ligament plication; Mc Call suture

3. Retrospective cohort study 2004-2009 179 patients Mean age 61 years Mean time followup 21 months 115 questionaire 64 % 123 POP-Q 69%

4. Pre- and postoperative POP-Q results prolapseAnterior preop Anterior postop Apical preop Apical postop Posterior preop Posterior postop 02.2 %48.4 %1.7 %82.9 %42.0 %63.6 % 114 %32.0 %22.7 %14.6 %38.1 %25.6 % 239.9 %19.7 %61.4 %0.8 %15.9 %9.1 % 342.1 %-13.1 %1.6 %4.0 %1.7 % 4 -1.1 %---

5. Patient satisfaction (very) satisfied 82 % moderate satisfied-dissatisfied18 % ◦ Recurrence 5 % recommend procedure91 % recovery postop < 3 months 96 % ◦ recovery postop < 4 weeks 50 %

6. Concluding message The modified Manchester operation is a safe procedure for treating pelvic organ prolapse with a low number of recurrent prolapse and a high level of patient satisfaction after surgery.

7. The Manchester Nine 1Hydrodissection 2Cervical circumcision 3Cuff preparation 4Bladder displacement 5Uterosacral ligament plication Mc Call suture 6Cardinal ligament plication 7Colporrhaphia anterior 8Cervical amputation-Sturmdorf suture 9Colporrhaphia posterior