# Manchester Operation > Manchester operation with cervical amputation and cardinal ligament plication, its indications, contraindications and complications for NEET-PG OBG. - Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/manchester-operation - Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-08 - Last updated: 2026-10-08 - Reference basis: Shaw's Textbook of Gynaecology; Dutta's Textbook of Gynecology; Williams Gynecology - How to cite: "Manchester Operation", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/manchester-operation ## Direct answer The Manchester operation is a uterus-conserving repair for uterine prolapse that combines amputation of an elongated cervix with plication of the cardinal ligaments and anterior colporrhaphy. It is indicated in women with uterine descent and an elongated cervix who wish to keep the uterus, and its main limitation is that the shortened cervix predisposes to cervical stenosis, haemorrhage and cervical incompetence in later pregnancy. It is therefore avoided in women who may still want children, and vaginal hysterectomy with native-tissue repair has largely replaced it in older women. ## What you must remember - **Steps:** amputation of the elongated cervix, plication of the cardinal ligaments in front of the cervical stump, and anterior colporrhaphy (with posterior colpoperineorrhaphy as needed), often described as the Manchester-Fothergill operation. - **Indication:** uterine descent with an elongated cervix in a woman who wants to keep her uterus, usually younger and without planned future pregnancy. - **Contraindication:** planned future pregnancy, because the amputated cervix raises the risk of cervical insufficiency and preterm delivery. - **Early complications:** haemorrhage, urinary retention, bladder injury during the anterior repair and wound infection. - **Late complications:** cervical stenosis, dyspareunia, and recurrence of cystocoele or uterine descent over time. - **Surveillance:** the retained cervical stump still needs cervical cytology screening, because the cervix is not removed. - **Comparison:** vaginal hysterectomy with native-tissue repair is preferred in most women, since it removes the uterus and avoids a retained cervix. ## A reasoned choice for a 38-year-old with descent A 38-year-old woman with two living children reports a bulge at the introitus, backache and a sense of heaviness, and examination shows uterine descent to the introitus with an elongated cervix. She does not want further children but wants to keep her uterus for reasons of menstrual health and personal preference. 1. **Confirm the site:** Check that the descent is uterine rather than purely anterior, because the Manchester operation addresses the cervix and the cardinal ligaments. 2. **Screen the cervix:** Check her cervical screening and exclude any cervical lesion, since the cervix is retained and needs ongoing surveillance. 3. **Compare the options:** A Manchester repair retains the uterus and treats the elongated cervix directly, whereas vaginal hysterectomy with anterior and posterior repair removes the uterus and avoids a retained cervix. 4. **Weigh the goal:** Manchester suits a woman who strongly wants her uterus and accepts long-term cervical follow-up, while a woman who values a definitive solution and is happy to lose the uterus is better served by hysterectomy. 5. **Settle the pregnancy plan:** Future pregnancy is the decisive question, because a woman who may conceive is not a candidate. The reasoning goes from anatomy to the pregnancy plan, and the surgery follows from that. ## Where the examiner sets the trap Three confusions recur in this operation. - **Trap:** Manchester and Le Fort are interchangeable — **Correct:** Manchester conserves the uterus and treats an elongated cervix, while Le Fort colpocleisis obliterates the vagina in frail elderly women who no longer want intercourse. - **Trap:** the operation suits a woman who still wants a child — **Correct:** the cervical amputation predisposes to cervical insufficiency and preterm delivery, so she is not a candidate. - **Trap:** Manchester fixes every compartment — **Correct:** it does not treat enterocele or vault weakness, and the posterior wall needs its own colpoperineorrhaphy. - **Trap:** cervical stenosis is an early complication — **Correct:** haemorrhage is the early concern, while cervical stenosis is a late complication and insufficiency shows up in a later pregnancy. ## Frequently asked questions ### What are the steps of the Manchester operation? The Manchester operation involves amputation of the elongated cervix, plication of the cardinal ligaments in front of the cervical stump, and anterior colporrhaphy. Together these shorten the cervix and tighten the supporting ligaments while conserving the uterus. ### Why is the Manchester operation avoided in women planning pregnancy? The Manchester operation is avoided in women planning pregnancy because the cervical amputation predisposes to cervical insufficiency and preterm delivery. The surgery therefore suits women who have completed childbearing and want to keep the uterus. ### Which complication of the Manchester operation is seen years later? Cervical stenosis, dyspareunia and recurrence of prolapse can appear years after the Manchester operation, and cervical cytology screening must continue because the cervix is retained. Late cervical insufficiency is recognised in a subsequent pregnancy. ### How does vaginal hysterectomy differ from the Manchester operation? Vaginal hysterectomy removes the uterus and cervix, whereas the Manchester operation conserves the uterus and amputates only the elongated cervix. Vaginal hysterectomy avoids a retained cervix and the associated screening, which is why it is preferred in most women today.