In Search for an Effective Conservative Surgery for Diffuse Adenomyosis in a Resource-Constrained Setting: Outcome of Open Double-Flap Adenomyomectomy in Infertile Women

Felix A. Elachi, Felix Adaoje Elachi, Kenneth Egwuda, Clement Ayuba, Clement Fateh Ayuba, ChineduG Obikili, Otobo I. Ujah, Dunah Aboki, Jane Orjiani, Nnaemeka Odoh, Amaka N. Ocheke
In: Gynecology Obstetrics & Reproductive Medicine · 2026 · pp. 1–7 · doi:10.21613/gorm.2025.1688 · W7203530219
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This prospective cohort study evaluated open double-flap adenomyomectomy in 24 infertile women with diffuse adenomyosis, demonstrating significant symptom relief and a pregnancy rate of one-third among those undergoing subsequent in vitro fertilization.

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This prospective observational cohort study evaluated the clinical and reproductive outcomes of open double-flap adenomyomectomy in twenty-four infertile women with diffuse adenomyosis within a resource-constrained setting. The procedure resulted in significant improvement in menorrhagia and dysmenorrhea scores over twelve months, although nearly thirty percent of patients required blood transfusions and one developed a postoperative pelvic abscess. Among the nine participants who subsequently underwent in vitro fertilization, three achieved pregnancy, indicating potential fertility benefits despite the small sample size and limited follow-up duration. This paper is centrally about adenomyosis — specifically assessing the efficacy and safety of a conservative surgical technique for managing diffuse disease in infertile patients.

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Abstract

OBJECTIVES: Adenomyosis is a common cause of pelvic pain, menorrhagia, and infertility in women of reproductive age. There remains a need for an effective fertility-sparing surgical option for managing diffuse adenomyosis. This study evaluated the clinical and reproductive outcomes of open double-flap adenomyomectomy in infertile women in a resource-poor setting. STUDY DESIGN: This prospective observational cohort study was conducted between July 2024 and December 2025. Twenty-four infertile women with diffuse adenomyosis underwent open double-flap adenomyomectomy and were followed up for 12 months. Clinical and postoperative outcomes were analyzed. The severity of menorrhagia and dysmenorrhea was assessed using a Visual Analog scale (VAS) serially over 12 months postoperatively. Reproductive outcomes were also evaluated in women who subsequently had assisted reproductive treatment. RESULTS: The mean age of the women studied was 40.9±5.6 years, while the average duration of infertility was 7.4±3.4 years. The mean uterine size was 17.3±2.5 weeks. Mean blood loss was 285±222.9 ml, and 29.2% of the women required blood transfusion. The average duration of surgery was 135.9±75.6 minutes. One woman (4.2%) developed postoperative pelvic abscess. Appreciable improvement in menorrhagia and dysmenorrhea was observed, as demonstrated by declining VAS scores during follow-up. Nine women underwent in vitro fertilization, of whom 3 achieved pregnancy. CONCLUSION: Double-flap open adenomyomectomy may result in symptom relief and appreciable fertility outcomes in women with diffuse adenomyosis. The procedure appears safe, with low complication
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Objectives

Adenomyosis is a common cause of pelvic pain, menorrhagia, and infertility in women of reproductive age. There remains a need for an effective fertility-sparing surgical option for managing diffuse adenomyosis. This study evaluated the clinical and reproductive outcomes of open double-flap adenomyomectomy in infertile women in a resource-poor setting. STUDY DESIGN: This prospective observational cohort study was conducted between July 2024 and December 2025. Twenty-four infertile women with diffuse adenomyosis underwent open double-flap adenomyomectomy and were followed up for 12 months. Clinical and postoperative outcomes were analyzed. The severity of menorrhagia and dysmenorrhea was assessed using a Visual Analog scale (VAS) serially over 12 months postoperatively. Reproductive outcomes were also evaluated in women who subsequently had assisted reproductive treatment.

Results

The mean age of the women studied was 40.9±5.6 years, while the average duration of infertility was 7.4±3.4 years. The mean uterine size was 17.3±2.5 weeks. Mean blood loss was 285±222.9 ml, and 29.2% of the women required blood transfusion. The average duration of surgery was 135.9±75.6 minutes. One woman (4.2%) developed postoperative pelvic abscess. Appreciable improvement in menorrhagia and dysmenorrhea was observed, as demonstrated by declining VAS scores during follow-up. Nine women underwent in vitro fertilization, of whom 3 achieved pregnancy.

Conclusion

Double-flap open adenomyomectomy may result in symptom relief and appreciable fertility outcomes in women with diffuse adenomyosis. The procedure appears safe, with low complication Downloads Downloads Published How to Cite Issue Section License Copyright (c) 2026 Felix Adaoje Elachi, Kenneth Egwuda, Clement Ayuba, Chinedu Obikili, Otobo Ujah, Dunah Aboki, Jane Orjiani, Nnaemeka Odoh, Amaka Ocheke This work is licensed under a Creative Commons Attribution 4.0 International License. All the articles published in GORM are licensed with "Creative Commons Attribution 4.0 License (CC BY 4.0)". This license entitles all parties to copy, share and redistribute all the articles, data sets, figures and supplementary files published in this journal in data mining, search engines, web sites, blogs and other digital platforms under the condition of providing references.

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