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

Libo Zhu, Shuyi Chen, Xuan Che, Ping Xu, Xiufeng Huang, Xinmei Zhang
Journal of pain research · 2019 · vol. Volume 12 , pp. 1917–1924 · doi:10.2147/jpr.s205561 · PMID:31303783 · W2956038218
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Laparotomy showed a higher 6-year effective rate and lower recurrence rate than laparoscopy for severe diffuse adenomyosis, though not statistically significant, with postoperative drug use potentially reducing recurrence.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This single-institution study compared laparoscopic versus laparotomic double-flap adenomyomectomy in 148 women with severe uterine diffuse adenomyosis, assessing long-term efficacy and recurrence over up to 6 years using outcomes such as dysmenorrhea remission and imaging-confirmed recurrence; women received GnRHa for 6 months pre- or immediately around the perioperative period and then LNG-IUS or oral contraceptives after surgery. At 6-year follow-up, the laparotomy group had a higher overall effective rate (75.0% vs 62.1%), while the laparoscopic group showed a higher cumulative recurrence (27.8% vs 17.1%), though neither difference reached statistical significance (P>0.05). Postoperative recurrence differed by hormonal regimen: recurrence was lower in patients receiving GnRHa plus Mirena or oral contraceptives versus GnRHa alone, and adenomyosis patients with coexisting endometriosis had higher recurrence than those without endometriosis in both surgical groups. The paper’s limitation is that the groups were assigned based on patient requirements rather than randomization. This paper is centrally about adenomyosis—long-term comparative outcomes of laparoscopic versus laparotomic double-flap adenomyomectomy for severe diffuse adenomyosis, including how coexisting endometriosis affects recurrence.

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Abstract

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. Keywords: adenomyosis, adenomyomectomy, efficacy, recurrence, treatment

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