Surgical Outcomes of Laparoscopic and Laparotomic Adenomyomectomy for Diffuse Adenomyosis: A Systematic Review and Meta-Analysis

OBJECTIVE: To compare the surgical outcomes of laparoscopic and laparotomic adenomyomectomy in patients with diffuse adenomyosis through a systematic review and meta-analysis. DATA SOURCES: A systematic literature search was conducted using MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, OVID, and Google Scholar from database inception through March 2025. METHODS OF STUDY SELECTION: This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 statement and was prospectively registered in PROSPERO (CRD420261300568). Studies reporting outcomes of laparoscopic and/or laparotomic adenomyomectomy in patients with diffuse adenomyosis and providing extractable quantitative data for at least one predefined outcome were included. Twenty-two retrospective studies were included in the quantitative synthesis. TABULATION, INTEGRATION AND RESULTS: Operative time, intraoperative blood loss, lesion weight, overall complication rates, recurrence rates, perioperative medical treatment characteristics, baseline clinical and symptom characteristics, coexistence of endometriosis, postoperative symptom outcomes, and reproductive outcomes were extracted and synthesized. No statistically significant differences were observed between laparoscopic and laparotomic adenomyomectomy regarding operative time, intraoperative blood loss, or overall complication rates. Laparotomic adenomyomectomy was associated with significantly greater resected lesion weight and lower recurrence rates compared with the laparoscopic approach. Additional subgroup analyses did not demonstrate statistically significant differences in perioperative medical treatment, postoperative symptom outcomes, or reproductive outcomes between the two approaches. CONCLUSION: Laparotomic adenomyomectomy was associated with greater lesion excision and lower recurrence rates than laparoscopic adenomyomectomy. Nevertheless, both approaches appear to be feasible uterus-preserving surgical options for diffuse adenomyosis. The choice of surgical approach should be individualized according to disease extent, surgeon experience, and patient expectations regarding symptom control, fertility preservation, and uterine preservation.