Surgical Treatment of Adenomyosis

Current Obstetrics and Gynecology Reports
Stavros Bischiniotis, Themistoklis Mikos, Grigoris Grimbizis

Tóm tắt

Abstract Purpose of Review Adenomyosis is defined as the presence of endometrial tissue within the myometrium. The aim of the review is to describe contemporary surgical approaches for adenomyosis. Recent Findings Hysterectomy has been standard practice for the treatment of adenomyosis for many years. However, uterine-sparing interventions have emerged recently allowing patients to retain or even enhance their fertility. If there is no wish for further fertility and no desire for uterine preservation, hysterectomy with bilateral salpingectomy is the gold standard treatment for symptomatic adenomyosis. Otherwise, the objectives of surgery are (a) to remove most (ideally the whole) of the adenomyotic tissue, (b) to preserve the integrity of the endometrial cavity, (c) to reconstruct the uterus, and (d) to preserve the functionality of the ovaries and the tubes. The following surgical methods have been proposed for uterus-sparing treatment of adenomyosis: classical excision of adenomyotic tissue after a single incision of the uterus, wedge resection, double- or triple-flap method, transverse H incision, and the PUSH technique. Post-operative clinical outcomes are in favor of fertility-sparing surgery of adenomyosis. The reduction of dysmenorrhea after uterus-sparing surgery for adenomyosis ranges from 54.6 to 84.6%. The reduction of menorrhagia ranges from 50.0 to 73.7%. The total delivery rate in patients who have undergone any uterus-sparing surgery for adenomyosis is 46.9%. Summary In conclusion, hysterectomy has traditionally been the primary treatment for adenomyosis in women. However, contemporary medicine offers several excisional and non-excisional techniques for patients who wish to preserve their fertility.

Từ khóa


Tài liệu tham khảo

Gaba ND, Polite FG, Keller JM, Young AE. Clin Obstet Gynecol. 2014;57:128–39.

Sun AJ, Luo M, Wang W, Chen R, Lang JH. Characteristics and efficacy of modified adenomyomectomy in the treatment of uterine adenomyoma. Chin Med J (Engl). 2011;124:1322–6.

Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Kumakiri J, Kitano T, et al. Laparoscopic adenomyomectomy and hysteroplasty: a novel method. J Minim Invasive Gynecol. 2006;13:150–4.

Osada H, Silber S, Kakinuma T, Nagaishi M, Kato K, Kato O. Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod Biomed Online. 2011;22:94–9.

Fujishita A, Masuzaki H, Khan KN, Kitajima M, Ishimaru T. Modified reduction surgery for adenomyosis: a preliminary report of the transverse H incision technique. Gynecol Obstet Invest. 2004;57:132–8.

Nishida M, Takano K, Arai Y, Ozone H, Ichikawa R. Conservative surgical management for diffuse uterine adenomyosis. Fertil Steril. 2010;94:715–9.

Wu R, Zeng L, Hu Q, Qu X, He F, Bao J, Wei W, Zhang W, Dai W, Li H, Du H, Li C. (2023) Outcome of uterine functional structures protection by fertility preservative PUSH surgery in diffuse adenomyosis. Hum Fertil. 2023;26:720–32. https://doi.org/10.1080/14647273.2023.2260102.

Otsubo Y, Nishida M, Arai Y, Ichikawa R, Taneichi A, Sakanaka M. Association of uterine wall thickness with pregnancy outcome following uterine-sparing surgery for diffuse uterine adenomyosis. Aust N Z J Obstet Gynaecol. 2016;56(1):88–91.

Yoon SH, Lee GJ, Cho HJ, Kwon H, Yun BS, Lee CH, Park HS, Roh J-W. Clinical efficacy of a novel method of fertility-preserving adenomyomectomy in infertile women with diffuse adenomyosis. Medicine. 2023;102(13):e33266. https://doi.org/10.1097/MD.0000000000033266.

Tskhay VB, Schindler AE, Mikailly GT. Diffuse massive adenomyosis and infertility. Is it possible to treat this condition? Horm Mol Biol Clin Invest. 2019;37(1):20180026.

Kitade M, Jinsushi M, Shinichiro I, Murakami K, Ozaki R, Masuda A, Kuroda K, Kumakiri J. Surgical treatments for adenomyosis. In: Sugino N, editor. Uterine fibroids and adenomyosis. Comprehensive gynecology and obstetrics. Singapore: Springer; 2018. p. 151–62. https://doi.org/10.1007/978-981-10-7167-6_11.

Yang B, Wang L, Wan X, Li Y, Yu X, Qin Y, Luo Y, Wang F, Huang O. Elevated plasma levels of lysophosphatidic acid and aberrant expression of lysophosphatidic acid receptors in adenomyosis. BMC Womens Health. 2017;17(1):118. https://doi.org/10.1186/s12905-017-0474-z.

Wang PH, Liu WM, Fuh JL, Cheng MH, Chao HT. Comparison of surgery alone and combined surgical-medical treatment in the management of symptomatic uterine adenomyoma. Fertil Steril. 2009;92(3):876–85. https://doi.org/10.1016/j.fertnstert.2008.07.1744.

• Nirgianakis K, Kalaitzopoulos DR, Schwartz ASK, Spaanderman M, Kramer BW, Mueller MD, et al. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis. Reprod Biomed Online. 2021;42(1):185–206. https://doi.org/10.1097/MD.0000000000033266. This is a review about the fertility outcomes in patients with adenomyosis. 

Youm HS, Choi YS, Han HD. In vitro fertilization and embryo transfer outcomes in relation to myometrial thickness. J Assist Reprod Genet. 2011; 28: 1135–40. https://doi.org/10.1007/s10815-011-9640-7.

Tan J, Moriarty S, Taskin O, Allaire C, Williams C, Yong P, et al. Reproductive outcomes after fertility-sparing surgery for focal and diffuse adenomyosis: a systematic review. J Minim Invasive Gynecol. 2018;25:608–21.

Matsuzaki S, Yoshino K, Tomimatsu T, Takiuchi T, Kumasawa K, Kimura T. Placenta accreta following laparoscopic adenomyomectomy: a case report. Clin Exp Obstet Gynecol. 2016;43(5):763–5. PMID: 30074335.

Kwack JY, Lee SJ, Kwon YS. Pregnancy and delivery outcomes in the women who have received adenomyomectomy: performed by a single surgeon by a uniform surgical technique. Taiwan J Obstet Gynecol. 2021;60(1):99–102. https://doi.org/10.1016/j.tjog.2020.11.015. PMID: 33495018.

Komatsu H, Taniguchi F, Harada T. Impact of adenomyosis on perinatal outcomes: a large cohort study (JSOG database). BMC Pregnancy Childbirth. 2023;23(1):579. https://doi.org/10.1186/s12884-023-05895-w. PMID:37568120; PMCID:PMC10422787.

Practice Committee of the American Society for Reproductive Medicine. Electronic address: [email protected]; Practice Committee of the American Society for Reproductive Medicine. Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline. Fertil Steril. 2017;108(3):416–425. https://doi.org/10.1016/j.fertnstert.2017.06.034. PMID: 28865538.

Cozzolino M, Cosentino M, Loiudice L, Martire FG, Galliano D, Pellicer A, Exacoustos C. Impact of adenomyosis on in vitro fertilization outcomes in women undergoing donor oocyte transfers: a prospective observational study. Fertil Steril. 2024;121(3):480–8. https://doi.org/10.1016/j.fertnstert.2023.11.034. PMID: 38043844.

Vercellini P, Viganò P, Bandini V, Buggio L, Berlanda N, Somigliana E. Association of endometriosis and adenomyosis with pregnancy and infertility. Fertil Steril. 2023;119(5):727–40. https://doi.org/10.1016/j.fertnstert.2023.03.018. PMID: 36948440.

Vercellini P, Consonni D, Dridi D, Bracco B, Frattaruolo MP, Somigliana E. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum Reprod. 2014;29(5):964–77.

Dedes I, Kolovos G, Arrigo F, Toub D, Vaineau C, Lanz S, Imboden S, Feki A, Mueller MD. Radiofrequency ablation for adenomyosis. J Clin Med. 2023;12(9):3069. https://doi.org/10.3390/jcm12093069. PMID: 37176514; PMCID: PMC10179480.

Thông tin
Thông tin xuất bản

Current Obstetrics and Gynecology Reports

Thông tin tác giả