<![CDATA[Apical prolapse with cervical elongation is a complex condition that requires correcting both apical support and cervical elongation to achieve optimal anatomical outcomes while preserving vaginal function. We report the case of a 45-year-old woman presenting with a vaginal bulge and abnormal uterine bleeding for more than four years. Examination revealed stage IV apical prolapse with cervical elongation, grade II cystocele and rectocele, and multiple uterine myomas measuring 3–7 cm. The patient had completed childbearing but wished to preserve sexual function. An abdominal subtotal hysterectomy was performed, followed by abdominal sacrocervicopexy (ASC) using mesh fixation from the cervical stump to the sacral promontory. Following apical suspension, intraoperative evaluation demonstrated persistent cervical elongation, with the cervix remaining less than 5 cm above the hymenal ring. Therefore, the Manchester procedure was performed to correct the residual cervical elongation. The combination of ASC and the Manchester procedure corrected both apical support and cervical elongation, with the final cervical position approximately 7 cm above the hymenal ring. At the 3-month follow-up, vaginal length remained well preserved. This case demonstrates that ASC with mesh-based apical suspension combined with the Manchester procedure can be considered when cervical elongation persists after apical suspension, allowing anatomical correction while preserving vaginal length and function.]]>
