A New Surgical Method of U-Shaped Myometrial Excavation and Modified Suture Approach with Uterus Preservation for Diffuse Adenomyosis

Jun-Min, Xie; Zhu, Kun Yan; Zhao, Yinkai; Zhang, Yaqin; Xiao-Fan, Fan; Xiao-Yu, Zhu; Li, Wei; Wang, Bin

doi:10.1155/2018/1657237

Cited by 7 publications

(12 citation statements)

References 16 publications

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“…Recently, one study by Kwack et al showed that dysmenorrhea was improved in 100% of the patients with diffuse uterine adenomyosis at the 7-month follow-up after adenomyomectomy using the muscle fold method 23. Another study by Jun-Min et al found that the effective rate was 94.9% in patients with diffuse uterine adenomyosis within 2 years after the U-shaped adenomyomectomy 24. Osada et al reported that the VAS score of dysmenorrhea was decreased from 10.00±0.00 pre-surgically to 1.67±1.79 at 2-year follow-up after the triple-flap method adenomyomectomy in patients with diffuse adenomyosis 22.…”

Section: Discussionmentioning

confidence: 99%

<p>Comparisons of the efficacy and recurrence of adenomyomectomy for severe uterine diffuse adenomyosis via laparotomy versus laparoscopy: a long-term result in a single institution</p>

Zhu¹,

Chen²,

Che³

et al. 2019

JPR

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Purpose Studies have shown that adenomyomectomy can effectively treat women with adenomyosis in a short period of time. However, the long-term efficacy of adenomyomectomy has rarely been reported. The objective of this study was to determine whether laparotomy is superior to laparoscopic surgery in the long-term efficacy of double-flap method adenomyomectomy for severe diffuse adenomyosis. Methods Between March 2011 and September 2018, a total of 148 patients with severe uterine diffuse adenomyosis who underwent laparoscopic (group A, n=72) and laparotomic (group B, n=76) double-flap adenomyomectomy were recruited. Adenomyomectomy efficacy and adenomyosis recurrence after surgery between groups A and B were comparatively analyzed. Results The effective rate at 6-year follow up after surgery was higher in group B (75.0%) than that in group A (62.1%), while the 6-year cumulative recurrence rate was higher in group A (27.8%) than that in group B (17.1%), but the differences did not reach statistical significance between the two groups ( P >0.05). The recurrence rate was lower in patients who were treated with gonadotropin-releasing hormone agonist (GnRHa) plus Mirena or oral contraceptives post-surgically than that in patients who were treated with only GnRHa post-surgically in groups A (51.6% vs 9.8%, P <0.01) and B (33.3% vs 6.5%, P <0.05). Moreover, the recurrence rate of adenomyosis patients with endometriosis was higher than that of adenomyosis patients without endometriosis in group A (55.0% vs 17.3%, P <0.05) and group B (36.0% vs 7.8%, P <0.05). Conclusion The long-term outcomes of laparoscopic and laparotomic double-flap adenomyomectomy can be achieved for severe diffuse uterine adenomyosis, but laparotomy seems to have advantages over laparoscopy. Postoperative drug use may be beneficial to reduce the recurrence of adenomyosis, especially for adenomyosis with endometriosis.

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Section: Discussionmentioning

confidence: 99%

<p>Comparisons of the efficacy and recurrence of adenomyomectomy for severe uterine diffuse adenomyosis via laparotomy versus laparoscopy: a long-term result in a single institution</p>

Zhu¹,

Chen²,

Che³

et al. 2019

JPR

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“…We included 38 trials, reporting on data from 5175 women ( Table I ) ( Fedele et al , 1997 ; Maia et al , 2003 ; Hadisaputra and Anggraeni, 2006 ; Bragheto et al , 2007 ; Kim et al , 2007 ; Cho et al , 2008 ; Kang et al , 2009 ; Sheng et al , 2009 ; Kang et al , 2010 ; Ozdegirmenci et al , 2011 ; Zhou et al , 2011 ; Kelekci et al , 2012 ; Ekin et al , 2013 ; Liu et al , 2014 ; Zhang et al , 2014 ; Huang et al , 2015 ; Lee et al , 2015 , 2019 ; Long et al , 2015 ; Chong et al , 2016 ; Liu et al , 2016 ; Park et al , 2016 ; Hai et al , 2017 ; Huang et al , 2017 ; Liu et al , 2017 ; Osuga et al , 2017 ; Yang et al , 2017 , 2019 ; Alizzi, 2018 ; Guo et al , 2018 ; Jun-Min et al , 2018 ; Li et al , 2018 , 2020 ; Huang et al , 2020 ; Lin et al , 2020 ; Sun et al , 2020 ; Kwack et al , 2021 ; Sun et al , 2021 ). There were six (16%) randomized controlled trials (RCTs) ( Hadisaputra and Anggraeni, 2006 ; Kang et al , 2010 ; Ozdegirmenci et al , 2011 ; Zhang ...…”

Section: Resultsmentioning

confidence: 99%

“…There were six (16%) randomized controlled trials (RCTs) ( Hadisaputra and Anggraeni, 2006 ; Kang et al , 2010 ; Ozdegirmenci et al , 2011 ; Zhang et al , 2014 ; Osuga et al , 2017 ; Lin et al , 2020 ); 13 studies (34%) were prospective, non-randomized trials, of which nine had cohorts with a single arm ( Fedele et al , 1997 ; Bragheto et al , 2007 ; Kim et al , 2007 ; Cho et al , 2008 ; Sheng et al , 2009 ; Zhou et al , 2011 ; Ekin et al , 2013 ; Alizzi, 2018 ; Yang et al , 2019 ) and four studies had two or more arms ( Kelekci et al , 2012 ; Huang et al , 2015 ; Yang et al , 2017 ; Li et al , 2018 ). There were 17 (45%) retrospective cohort studies, 12 with a single arm ( Kang et al , 2009 ; Liu et al , 2014 , 2016 ; Lee et al , 2015 , 2019 ; Long et al , 2015 ; Chong et al , 2016 ; Park et al , 2016 ; Hai et al , 2017 ; Huang et al , 2017 ; Jun-Min et al , 2018 ; Kwack et al , 2021 ) and five with two or more arms ( Maia et al , 2003 ; Liu et al , 2017 ; Guo et al , 2018 ; Huang et al , 2020 ; Li et al , 2020 ). Two studies with a single cohort did not specify if the cohort was retrospective or prospective ( Sun et al , 2020 , 2021 ).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of outcome reporting and outcome measures in studies investigating uterine-sparing treatment for adenomyosis

Tellum

Omtvedt

Naftalin

et al. 2021

Human Reproduction Open

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STUDY QUESTION Which outcomes and outcome measures are reported in interventional trials evaluating the treatment of adenomyosis? SUMMARY ANSWER We identified 38 studies, reporting on 203 outcomes using 133 outcome measures. WHAT IS KNOWN ALREADY Heterogeneity in outcome evaluation and reporting has been demonstrated for several gynaecological conditions and in fertility studies. In adenomyosis, previous systematic reviews have failed to perform a quantitative analysis for central outcomes, due to variations in outcome reporting and measuring. STUDY DESIGN, SIZE, DURATION A systematic search of Embase, Medline and Cochrane Register of Controlled Trials (CENTRAL) was performed with a timeframe from 1950 until February 2021, following the preferred reporting items for systematic reviews and meta-analysis (PRISMA). PARTICIPANTS/MATERIALS, SETTING, METHODS Studies reporting on any uterus-sparing intervention to treat adenomyosis, both prospective and retrospective, were eligible for inclusion. Inclusion criteria were a clear definition of diagnostic criteria for adenomyosis and the modality used to make the diagnosis, a clear description of the intervention, a follow up time of ≥ 6 months, a study population of n ≥ 20, a follow up rate of at least 80%, and English language. The population included premenopausal women with adenomyosis. Risk of bias was assessed using the Evidence Project risk of bias tool. MAIN RESULTS AND THE ROLE OF CHANCE We included 38 studies (6 randomized controlled trials and 32 cohort studies), including 5175 participants with adenomyosis. The studies described 10 interventions and reported on 203 outcomes, including 43 classified as harms, in 29 predefined domains. Dysmenorrhea (reported in 82%), heavy menstrual bleeding (HMB) (in 79%) and uterine volume (in 71%) were the most common outcomes. Fourteen different outcome measures were used for dysmenorrhea and 17 for HMB. Quality of life was reported in 9 (24%) studies, patient satisfaction with treatment in 1 (3%). A clear primary outcome was stated in only 18%. LIMITATIONS, REASONS FOR CAUTION This review includes studies with a high risk of bias. WIDER IMPLICATIONS OF THE FINDINGS Shortcomings in the definition and choice of outcomes and outcome measures limit the value of the conducted research. The development and implementation of a core outcome set (COS) for interventional studies in adenomyosis could improve research quality. This review suggests a lack of patient centred research in adenomyosis and people with adenomyosis should be involved in the development and implementation of the COS. STUDY FUNDING/COMPETING INTEREST(S) No funds specifically for this work was received. TT receives fees from General Electrics for lectures on ultrasound independently of this project. TRIAL REGISTRATION NUMBER This review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020177466) and the Core Outcome Measures in Effectiveness Trials (COMET) initiative (registration number 1649).

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“…8,10,12,13 A 2-year follow-up study of 198 patients found similar improvement in pain scores and abnormal bleeding. 15…”

Section: Quality Of Lifementioning

confidence: 99%

“…13 These findings have been supported in other studies. 8,15,16 In a study of 224 patients undergoing abdominal and laparoscopic adenomyomectomy, there were no significant differences in dysmenorrhea rates at 7-month follow-up, though both treatment modalities appeared to be effective in treating dysmenorrhea when compared with baseline. 8…”

Section: Pelvic Painmentioning

confidence: 99%

Current and Future Surgical and Interventional Management Options for Adenomyosis

2020

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Historically, hysterectomy has been the recommended treatment for patients with adenomyosis. However, in the past two decades, various uterine-sparing treatment methods have emerged. These range from excisional techniques such as adenomyomectomy or wedge resection to uterine artery embolization, radiofrequency thermal ablation, hysteroscopic excision, endometrial ablation, and high-intensity focused ultrasound. While largely investigative for the treatment of adenomyosis, these procedures have demonstrated improvement in symptoms including abnormal uterine bleeding, dysmenorrhea, pelvic pain, and overall quality of life. However, long-term data including fertility and obstetric outcomes are needed. Future research is needed to better understand the impact of these uterine-preserving techniques to expand our armamentarium for the treatment of adenomyosis.

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A New Surgical Method of U-Shaped Myometrial Excavation and Modified Suture Approach with Uterus Preservation for Diffuse Adenomyosis

Cited by 7 publications

References 16 publications

<p>Comparisons of the efficacy and recurrence of adenomyomectomy for severe uterine diffuse adenomyosis via laparotomy versus laparoscopy: a long-term result in a single institution</p>

<p>Comparisons of the efficacy and recurrence of adenomyomectomy for severe uterine diffuse adenomyosis via laparotomy versus laparoscopy: a long-term result in a single institution</p>

A systematic review of outcome reporting and outcome measures in studies investigating uterine-sparing treatment for adenomyosis

Current and Future Surgical and Interventional Management Options for Adenomyosis

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