Conservative surgical management for diffuse uterine adenomyosis

Adenomyosis: A Clinical Review of a Challenging Gynecologic Condition

“…Additionally this method causes uterine scaring, which may contain small areas of adenomyosis leading to decreased uterine wall strength and increased risk of uterine rupture. 82,85,96 Although pregnancy rates following these procedures have been low, these small studies have shown an improvement in dysmenorrhea and heavy menstrual bleeding, and therefore these conservative surgeries may be an option for patients with symptomatic diffuse adenomyosis who want to preserve their uterus. 96…”

“…Nishida et al 96 described covering the remaining part of the uterus with myometrium. They found this method was not very successful as women developed adenomyosis and required hysterectomy within 1 year 96. Fujishita et al 97 describe a second method; in their modified method a transverse H incision is completed.…”

“…Following surgery menstruation resumed in all women within 3 months, and there was an improvement in dysmenorrhea, menstrual blood loss, and anemia. Additionally 2 women became pregnant after surgery; one had an interstitial pregnancy and the other was still pregnant after IVF/ET during the time of publication 96. …”

Heavy menstrual bleeding and dysmenorrhea are improved by Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS) of adenomyosis

“…The concept of conservative uterus – sparing surgery is increasing but it has not yet become the standard [26]. It involves techniques that modify the anatomy of the uterus and this may contribute to a declined post pregnancy rate [27]. Of those seeking fertility treatment post MRgFUS in our study population (13/26), treatment for infertility was started 3 months post MRgFUS.…”

Contemporary Methods of Operative Treatment of Severe Adenomyosis

“…Эта операция относится к циторедуктивным хирургическим технологиям, которые предусматривают неполное удаление очага поражения. Эти виды операций также используется в случаях диффузного аде-номиоза и предусматривает частичное удаление клинически разпознанных очагов аденомиоза [5,7,20]. По данным G.F. Grimbizis (2014), после частичного иссечения участков аденомиоза умень-шение дисменореи наблюдалось в 81,8% случаев, меноррагии -в 50%, а частота наступления бере-менности -в 46,9% случаев [11].…”