Journal of Gynecology and Obstetrics

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Conservative Surgery in the Management of Adenomyosis

Received: 29 December 2018    Accepted: 11 February 2019    Published: 28 February 2019
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Abstract

Since 2002, we have performed adenomyomectomy for 1780 women with uterine adenomyosis. We classified adenomyosis in these patients as focal (n=1313), diffuse (n=450) or cystic (n=17) type according to the distribution of the focuses seen in magnetic resonance imaging (MRI) findings. Three different surgical methods for focal, diffuse and cystic adenomyosis are utilized at our institution. The adenomyosis lesion is excised using a loop electrode of a high-frequency cutter in all methods. The median resected lesion weight of focal, diffuse and cystic adenomyosis were 94 g (1-1156 g), 150 g (10-1595 g), and 16 g (3-45 g), respectively. The mean visual analogue score for dysmenorrhea decreased from 9.1 to 1.0 and heavy menstrual bleeding was improved in all cases. Following the procedure, 370 pregnancies occurred in 294 patients, of which 153 (41.9%) were the result of natural conception. Pregnancy rate of the patients younger than 40 years were 35.1% in focal type, 25.4% in diffuse type and 88.9% in cystic type. Among those patients, we experienced 5 cases of uterine rupture. Of 1462 patients who underwent surgery more than 2 years prior to the time of writing, recurrence occurred in 150 (10.3%). Our findings indicate that conservative surgery for uterine adenomyosis using a high-frequency resection device is effective for both focal and diffuse type.

DOI 10.11648/j.jgo.20190701.12
Published in Journal of Gynecology and Obstetrics (Volume 7, Issue 1, January 2019)
Page(s) 8-16
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Adenomyosis, Conservative Surgery, Classification, Prognosis, Pregnancy, Recurrence

References
[1] G. Younes and T. Tulandi (2018) Conservative surgery for adenomyosis and results: A systematic review. J Minim Invasive Gynecol. 25, 265-276.
[2] H. Takeuchi, M. Kitade, I. Kikuchi, J. Kumakiri, K. Kuroda, and M. Jinushi (2010) Diagnosis, laparoscopic management, and histopathologic findings of juvenile cystic adenomyoma: a review of nine cases. Fertil Steril 94,862-868.
[3] A. Kriplani, R. Mahey, N. Agarwal, N. Bhatla, R. Yadav, and M. Singh (2011) Laparoscopic management of juvenile cystic adenomyoma: four cases. J Minim Invasive Gynecol 18,343-348.
[4] L. Fedele, S. Bianchi, F. Zanotti, M. Marchini, and G. Candiani (1993) Fertility after conservative surgery for adenomyomas. Hum Reprod 8,1708-1710.
[5] Y. S. Kwon, H. J. Roh, J. W. Ahn, S. H. Lee, and K. S. Im (2015) Conservative adenomyomectomy with transcient occulusion of uterine arteries for diffuse uterine adenomyosis. J Obstet Gynecol Res 41,938-945.
[6] J. K. Kim, C. S. Shin, Y. B. Ko, S. Y. Nam, H. S. Yim, K. and H. Lee (2014) Laparoscopic assisted adenomyomectomy using double flap method. Obstet Gynecol Sci 57,128-135.
[7] A. Saremi, H. Bahrami, P. Salehian, N. Hakak, and A. Pooladi (2014) Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique. Reprod Biomed Online 28,753-760.
[8] Y. S. Kwaon, H. J. Roh, J. W. Ahn, S. H. Lee, and K. S. Im (2013) Laparoscopic adenomyomectomy under transient occlusion of uterine arteries with an endoscopic vascular clip. J Laparoendosc Adv Surg Tech 23,866-870.
[9] W. M. Liu, C. H.Chen, L. H. Chiu, and C. R. Tzeng (2013) Long-term follow-up of severely symptomatic women with adenomyoma treated with combination therapy. Taiwan J Obstet Gynecol 52,85-89.
[10] Z. Dai, X. Feng, L. Gao, and M. Huang (2012) Local excision of uterine adenomyomas: a report of 86 cases with follow-up analysis. Eur J Obstet Gynecol Reprod Biol 161, 84-87.
[11] H. Osada, S. Silber, T. Kakinuma, M. Nagaishi, K. Kato, and O. Kato (2011) Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod Biomed Online 22,94-99.
[12] A. Jama FE (2011) Management of adenomyosis in subfertile women and pregnancy outcome. Oman Med J 26,178-181.
[13] A. J. Sun, M. Luo, W. Wang, R. Chen, and J. Lang (2011) Characteristics and efficacy of modified adenomyomectomy in the treatment of uterine adenomyoma. Chin Med J 124,1322-1326.
[14] Y. S. Kwon, Y. J. Koo, and K. S. Im (2011) Conservative surgical treatment combined with Gn-RH agonist in symptomatic uterine adenomyosis. Pak J Med Sci 27,365-370.
[15] P. H. Wang, W. M. Liu, J. L. Fuh, M. H. Cheng, and H. T. Chao (2009) Comparison of surgery alone and combined surgical-medical treatment in the management of symptomatic uterine adenomyoma. Fertil Steril 92,876-885.
[16] P. H. Wang, J. L. Fuh, H. T. Chao, W. M. Liu, M. H. Cheng, and K. C. Chao (2009) Is the surgical approach beneficial to subfertile women with symptomatic extensive adenomyosis? J Obstet Gynecol Res 35,495-502.
[17] G. Grimbizis, T. Mikos, L. Zepiridis, T. Theodridis, D. Miliaras, B. Tariatzis, and J. Bontis (2008) Laparoscopic excision of uterine adenomyomas. Fertil Steril 89,953-961.
[18] H. Takeuchi, M. Kitade, I. Kikuchi, H. Shimanuki, J. Kumakiri, T. Kitano, and K. Kinoshita (2006) Laparoscopic adenomyomectomy and hysteroplasty: a novel method. J Minim Invasive Gynecol 13,150-154.
[19] C. Wood (1998) Surgical and medical treatment of adenomyosis. Hum Reprod Update 4,150-154.
[20] M. Nishida, K. Takano, Y. Arai, H. Ozone, and R. Ichikawa (2010) Conservative surgical management for diffuse uterine adenomyosis. Fertil Steril 94, 715-719.
[21] A. Fujishita, H. Masuzaki, K. N. Khan, M. Kitajima, and T. Ishimaru (2004) Modified reduction surgery for adenomyosis. A preliminary report of the transverse H incision technique. Gynecol Obstet Invest 57,132-138.
[22] S. Preutthipan, and Y. Herabutya (2010) Hysteroscopic rollerball endometrial ablation as an alternative treatment for adenomyosis with menorrhagia and/or dysmenorrhea. J Obstet Gynecol Res 36,1031-1036.
[23] L. Kang, J. Gong, Z. Cheng, H. Dai, and H. Liping (2009) Clinical application and midterm results of laparoscopic partial resection of symptomatic adenomyosis combined with uterine artery occlusion. J Minim Invasive Gynecol 16,169-173.
[24] C. J. Wang, C. F. Yen, C. L Lee, and Y. K. Soong (2002) Laparoscopic uterine artery ligation for treatment of symptomatic adenomyosis. J Am Assoc Gynecol Laparosc 9,293-296.
[25] C. Wood, P. Maher, and D. Hill (1993) Biopsy diagnosis and conservative surgical treatment of adenomyosis. Aust N Z J Obstet Gynecol 33,319-321.
[26] C. Wood, P. Maher, and D. Hill (1994) Biopsy diagnosis and concervative surgical treatment of adenomyosis. J Am Assoc Gynecol Laparosc 1,(4 Pt 1)313-316.
[27] H. Maia, A. Maltez, G. Coelho, C. Athayde, and E. Countinho (2003) Insertion of mirena after endometrial resection in patients with adenomyosis. J Am Assoc Gynecol Laparosc 10,512-516.
[28] D. Phillips, H. Nathanson, S. Milim, and J. Haselkorn (1996) Laparoscopic bipolar coagulation for the conservative treatment of adenomyomata. J Am Assoc Gynecol Laparosc 4,19-24.
[29] T. Cullen (1908) Adnomyoma of the uterus. Philadelphia, PA: W.B. Saunders.
[30] Y. Kishi, H. Suginami, R. Kuramori, M. Yabuta, R. Suginami, and F. Tniguchi (2012) Four subtypes of adenomyosis assessed by magnetic resonance imaging and their specification. Am J Obstet Gynecol 207,114. E1-e7.
[31] M. Nishida, H. Itagaki, Y. Otsubo, R. Ichikawa, Y. Arai, and M. Sakanaka: Histogenesis and classification of diffuse and cystic adenomyosis. J Endometr Pelvic Pain Disord doi:10.1177/2284026518762926.
[32] M. Nishida, Y. Otsubo, Y. Arai, R. Ichikawa, Y. Kondo, H. Itagaki, and M. Sakanaka (2018) Uterine rupture during subsequent pregnancy following adenomyomectomy – Report of five cases and proposal of prevention.Int J Womens Health Wellness 4,70. doi: 10.23937/2474-1353/1510070.
Author Information
  • Department of Obstetrics and Gynecology, National Hospital Organization, Kasumigaura Medical Center, Tsuchiura, Japan

  • Department of Obstetrics and Gynecology, National Hospital Organization, Kasumigaura Medical Center, Tsuchiura, Japan

  • Department of Obstetrics and Gynecology, National Hospital Organization, Kasumigaura Medical Center, Tsuchiura, Japan

  • Department of Obstetrics and Gynecology, National Hospital Organization, Kasumigaura Medical Center, Tsuchiura, Japan

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  • APA Style

    Masato Nishida, Hiroya Itagaki, Yasuo Otsubo, Yuko Arai. (2019). Conservative Surgery in the Management of Adenomyosis. Journal of Gynecology and Obstetrics, 7(1), 8-16. https://doi.org/10.11648/j.jgo.20190701.12

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    ACS Style

    Masato Nishida; Hiroya Itagaki; Yasuo Otsubo; Yuko Arai. Conservative Surgery in the Management of Adenomyosis. J. Gynecol. Obstet. 2019, 7(1), 8-16. doi: 10.11648/j.jgo.20190701.12

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    AMA Style

    Masato Nishida, Hiroya Itagaki, Yasuo Otsubo, Yuko Arai. Conservative Surgery in the Management of Adenomyosis. J Gynecol Obstet. 2019;7(1):8-16. doi: 10.11648/j.jgo.20190701.12

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  • @article{10.11648/j.jgo.20190701.12,
      author = {Masato Nishida and Hiroya Itagaki and Yasuo Otsubo and Yuko Arai},
      title = {Conservative Surgery in the Management of Adenomyosis},
      journal = {Journal of Gynecology and Obstetrics},
      volume = {7},
      number = {1},
      pages = {8-16},
      doi = {10.11648/j.jgo.20190701.12},
      url = {https://doi.org/10.11648/j.jgo.20190701.12},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.jgo.20190701.12},
      abstract = {Since 2002, we have performed adenomyomectomy for 1780 women with uterine adenomyosis. We classified adenomyosis in these patients as focal (n=1313), diffuse (n=450) or cystic (n=17) type according to the distribution of the focuses seen in magnetic resonance imaging  (MRI) findings. Three different surgical methods for focal, diffuse and cystic adenomyosis are utilized at our institution. The adenomyosis lesion is excised using a loop electrode of a high-frequency cutter in all methods. The median resected lesion weight of focal, diffuse and cystic adenomyosis were 94 g (1-1156 g), 150 g (10-1595 g), and 16 g (3-45 g), respectively. The mean visual analogue score for dysmenorrhea decreased from 9.1 to 1.0 and heavy menstrual bleeding was improved in all cases. Following the procedure, 370 pregnancies occurred in 294 patients, of which 153 (41.9%) were the result of natural conception. Pregnancy rate of the patients younger than 40 years were 35.1% in focal type, 25.4% in diffuse type and 88.9% in cystic type. Among those patients, we experienced 5 cases of uterine rupture. Of 1462 patients who underwent surgery more than 2 years prior to the time of writing, recurrence occurred in 150 (10.3%). Our findings indicate that conservative surgery for uterine adenomyosis using a high-frequency resection device is effective for both focal and diffuse type.},
     year = {2019}
    }
    

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    T1  - Conservative Surgery in the Management of Adenomyosis
    AU  - Masato Nishida
    AU  - Hiroya Itagaki
    AU  - Yasuo Otsubo
    AU  - Yuko Arai
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    T2  - Journal of Gynecology and Obstetrics
    JF  - Journal of Gynecology and Obstetrics
    JO  - Journal of Gynecology and Obstetrics
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    PB  - Science Publishing Group
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    UR  - https://doi.org/10.11648/j.jgo.20190701.12
    AB  - Since 2002, we have performed adenomyomectomy for 1780 women with uterine adenomyosis. We classified adenomyosis in these patients as focal (n=1313), diffuse (n=450) or cystic (n=17) type according to the distribution of the focuses seen in magnetic resonance imaging  (MRI) findings. Three different surgical methods for focal, diffuse and cystic adenomyosis are utilized at our institution. The adenomyosis lesion is excised using a loop electrode of a high-frequency cutter in all methods. The median resected lesion weight of focal, diffuse and cystic adenomyosis were 94 g (1-1156 g), 150 g (10-1595 g), and 16 g (3-45 g), respectively. The mean visual analogue score for dysmenorrhea decreased from 9.1 to 1.0 and heavy menstrual bleeding was improved in all cases. Following the procedure, 370 pregnancies occurred in 294 patients, of which 153 (41.9%) were the result of natural conception. Pregnancy rate of the patients younger than 40 years were 35.1% in focal type, 25.4% in diffuse type and 88.9% in cystic type. Among those patients, we experienced 5 cases of uterine rupture. Of 1462 patients who underwent surgery more than 2 years prior to the time of writing, recurrence occurred in 150 (10.3%). Our findings indicate that conservative surgery for uterine adenomyosis using a high-frequency resection device is effective for both focal and diffuse type.
    VL  - 7
    IS  - 1
    ER  - 

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