Surgical Treatment of Adenomyosis

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.