Manchester surgery

Manchester surgery is used for surgical treatment of uterine prolapse. The external cervix descends below the plane of the ischial spine, which is called uterine prolapse. The cervix descended, but did not reach the vaginal opening, which was lighter than I; the cervix descended to the vaginal opening and was not exported, which was I degree. The cervix is removed from the vaginal opening, and the uterus is still in the vagina, which is lighter to the second degree; the cervix and part of the uterus are removed from the vaginal opening, which is II degree. The cervix and the uterus are all removed from the vaginal opening, which is called III degree uterine prolapse. Often accompanied by varying degrees of vaginal anterior and posterior wall bulging and cervical elongation. In 1888, Donald of Manchester, England began to treat uterine prolapse with vaginal anterior and posterior wall repair and partial cervical resection, first known as Donald surgery. In 1908, Fothergill was improved in the city, with a triangular incision in the anterior wall of the vagina, a tip in the lower urethra, and a basal in front of the cervix, which can expose the tissues on both sides of the cervix and suture it in front of the cervix to shorten the main ligament. The current practice is determined by the Shaw of the city. In 1933, Shaw named the surgery Manchester Opera. Treating diseases: uterine prolapse Indication Manchester surgery is suitable for I degree or II degree uterine prolapse, accompanied by cervical prolapse, hope to retain the uterus. Contraindications Same as anterior and posterior wall repair. After partial cervical resection, cervical dysfunction, less chance of conception, pregnancy, abortion, premature birth and dystocia have more opportunities, so hope that fertility should be carefully considered. Surgical procedure 1. Routine disinfection of the vulva and vagina, cover the disinfection towel. Guide the catheter with a metal catheter. Use the No. 4 silk thread to sew the labia minora on both sides of the labia majora to expose the vestibule. Use the vaginal retractor to open the vagina, expose the cervix, and then clamp the anterior lip of the cervix with double-jaw forceps or tissue forceps and pull it toward the vaginal opening. Note procaine or saline plus an appropriate amount of adrenaline (hypertensive disabled) into the vaginal mucosa, the sides of the bladder and so on. The anterior wall of the vagina is curved under the bladder groove, and the sides should reach the side. 2. Use curved scissors to extend from the incision between the vaginal wall and the bladder wall. The scissors tip should be placed against the vaginal wall. One by one, separate the vaginal wall from the bladder, and carefully approach the urethral opening to the urethral opening about 1 cm. Cut the anterior wall of the vagina after the longitudinal shape. The slit has an inverted T shape. 3. Hold the cut vaginal anterior wall with a rat tooth forceps and pull to both sides to expose the bladder under the incision. Bluntly separate, push the pubis cervix fascia to reach the inner edge of the puborectalis muscle. 4. Pull the cervix down and see that the bladder is attached to the cervix. A layer of fascia is placed at the junction of the bladder and the cervix, and the fascia is cut and extended to both sides. 5. Wrap the finger with gauze, separate the loose connective tissue between the bladder and the cervix, push up the pleats of the bladder uterus and free the bladder. The anterior wall of the vagina can also be cut according to Fothergill's procedure, that is, it is triangular, the tip is about 1cm below the urethral opening, the bottom is along the line of the bladder groove, and it is extended to the sides, and the two sides are outwardly curved and slightly curved. 6. Pull the uterus forward and upward, expose the posterior wall of the vagina, cross the incision along the cervix, extend backwards, and cut around the cervix for 1 week. The posterior wall of the vagina and the posterior part of the cervix are separated to reveal the main ligaments on both sides of the cervix. The curved hemostatic forceps clamped the main ligament close to the cervix, cut it, and sewed the end with a 2-0 chrome gut. The contralateral main ligament is treated in the same way. 7. Cut the extended cervix, which is slightly conical with the cervix perpendicular or slightly inward. 8. Use a triangular curved needle with a 1-0 chrome gut, pass through the left and right horns of the cervical tissue, and sew the descending branch of the uterine artery to reduce bleeding in the cervical section. One end of the gut is treated with a triangular curved needle with a No. 1 chrome gut, passing through the midpoint of the posterior lip of the cervix, and then pierced into the posterior wall of the cervix through the cervical canal, and out of the cervix to the outside of the mucosa; the other end is treated the same way. The two needles are separated by a distance of about 0.5cm, and the mucosa is covered by the posterior lip wound. 9. The main ligaments on both sides were sutured in front of the cervix with a 1-0 chrome gut and fixed on the cervix. 10. Suture the fascia on both sides of the bladder and urethra relative to the midline. 11. Cut off the excess anterior wall of the vagina. The lower end of the anterior wall of the vagina is decorated with a triangular curved needle with a No. 1 chrome gut as the posterior lip, passing through the midpoint of the mucosa at the lower end of the anterior wall of the vagina, piercing the anterior wall of the cervical canal, and penetrating the anterior cervix; One end is treated in the same way, and the ligation is performed. The mucosa of the anterior wall of the vagina covers the anterior lip of the cervix. The mucosa of the anterior and posterior vaginal cortex on both sides of the cervix was sutured with the gut relatively intermittently. Finally, the vaginal anterior wall was sutured to the midline. Posterior vaginal wall repair with anterior and posterior vaginal wall repair. complication 12.1 1. Hemorrhage or hematoma Intraoperative vascular or stump ligation is not strong, a large amount of bleeding can occur in a short time after surgery, the vaginal wall suture should be disassembled, the bleeding blood vessels should be searched, and the suture should be re-sewn. If only a small amount of bleeding, gauze can be used to fill the vaginal pressure to stop bleeding, and use hemostasis drugs such as Yunnan Baiyao. 2. Wound infection There are many vaginal folds, so it is not easy to completely disinfect. The accumulation of small blood vessels in the surgical field is conducive to bacterial reproduction, and hematoma formation after surgery is more likely to occur. The vaginal purulent secretion in the vagina of the light is accompanied by a vaginal burning sensation; the body temperature fluctuates and rises, the vaginal wall suture is healed or necrotic, there is purulent secretion, antibiotics can be applied, drainage, And keep the vulva clean. 3. Urinary tract complications 1 less urine (<600ml / d), due to postoperative reluctance to drink water or hot days, should be supplemented with intravenous saline or 5% glucose solution; 2 urethritis, cystitis, mostly due to repeated catheterization Cause, there are frequent urination, urgency, hematuria and other symptoms, given antibiotics, diuretics and other treatment.

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