Conservative surgery of uterine adenomyosis via laparoscopic versus laparotomic approach in a single institution

Kwack, Jae Young; Im, Kyong Shil; Kwon, Young-Soon

doi:10.1111/jog.13658

Cited by 16 publications

(25 citation statements)

References 15 publications

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“…Our current results showed that the effective rate was almost 100% within 2 years after laparoscopic or laparotomic adenomyomectomy by using the modified double-flap method in patients with severe diffuse uterine adenomyosis, which confirmed our previous results 1. 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.…”

Section: Discussionsupporting

confidence: 89%

“…However, the long-term efficacy of adenomyomectomy is rarely reported. Although there are long-term data in the literature, the evaluation of efficacy is still short term 18,23. Our results showed that although the therapeutic efficacy was decreased with the prolongation of postoperative time after laparoscopic or open adenomyomectomy, yet, the effective rate was both more than 60.0% at 6-year follow-up after surgery.…”

Section: Discussionmentioning

confidence: 61%

“…Obviously, in terms of adenomyomectomy for the treatment of uterine diffuse adenomyosis, laparotomy seems to have an advantage to laparoscopy. Therefore, for near-complete excision of adenomyosis, especially for these patients who preserve fertility, diffuse adenomyotic lesions may be recommended to be treated with laparotomic adenomyomectomy while focal lesions less than 5 cm could be treated with laparoscopic conservative surgery 18,23…”

Section: Discussionmentioning

confidence: 99%

“…In addition, our study also found that the recurrence rate in patients with diffuse adenomyosis was higher after laparoscopic adenomyomectomy compared with that after laparotomic adenomyomectomy, although there was no significant difference of adenomyosis recurrence between laparoscopic and laparotomic adenomyomectomy. Obviously, laparotomic adenomyomectomy seems to have an advantage over laparoscopic adenomyomectomy in terms of adenomyosis recurrence 18,23. Nevertheless, in order to obtain good surgical results, conservative surgery should also consider the patient’s age, serum CA125 levels, and uterine size as well as the extent and type of adenomyosis.…”

Section: Discussionmentioning

confidence: 99%

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<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: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

<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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“…As the myometrium of each flap is placed on top of each other and sutured together, this optimizes wound healing and may theoretically strengthen the myometrium to prevent future rupture. 8,9 Each layer is closed with a delayed absorbable suture in a running fashion until all dead space has been reapproximated. This is a complex, technically challenging procedure when performed laparoscopically or abdominally, and reports have largely come from high-volume centers.…”

Section: Surgical Techniquementioning

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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The Asian Society of Endometriosis and Adenomyosis guidelines for managing adenomyosis

Harada,

Taniguchi,

Guo

et al. 2023

Reprod Medicine & Biology

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Conservative surgery of uterine adenomyosis via laparoscopic versus laparotomic approach in a single institution

Cited by 16 publications

References 15 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>

Current and Future Surgical and Interventional Management Options for Adenomyosis

The Asian Society of Endometriosis and Adenomyosis guidelines for managing adenomyosis

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