The Outcome of Fertility-Sparing and Nonfertility-Sparing Surgery for the Treatment of Adenomyosis. A Systematic Review and Meta-analysis

Themistoklis Mikos, Lioupis M, Matteo Lioupis, Christos Anthoulakis, Grimbizis GF, Grigoris F Grimbizis, Grigoris Grimbizis
Journal of Minimally Invasive Gynecology · 2019 · vol. 27(2) , pp. 309–331.e3 · doi:10.1016/j.jmig.2019.08.004 · PMID:31398415 · W2966361532
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This systematic review and meta-analysis compared fertility-sparing and nonfertility-sparing surgical outcomes for treating adenomyosis.

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Abstract

ObjectiveThe purpose of this systematic review was to identify the operative issues and specific dysmenorrhea and menorrhagia outcomes in women who had undergone fertility-sparing surgery, as well as determine the expected outcome for extirpative surgery.Data sourcesPROSPERO (ID no. 125692). Search was conducted for eligible studies up to March 31, 2019, on MEDLINE/PubMed (1966-2019), Scopus/Elsevier (1950-2019), and Google Scholar (up to 2019). The search terms applied for the search strategy were as follows: adenomyosis, adenomyomas, uterus-sparing surgery, fertility-sparing surgery, pain, dysmenorrhea, menorrhagia, uterine volume, adenomyotic volume, case-control studies, cohort studies, and prospective studies.Methods of study selectionA total of 443 studies were initially identified. Exclusion criteria was as follows: (1) inadequate description of preoperative adenomyosis or absence of postoperative histology confirmation of adenomyosis, (2) no statement of use of a standardized instrument for measurement of pain, bleeding, or adenomyotic/uterine volume, (3) follow-up <12 months postoperatively, (4) study population <20 women, and (5) non-English language.Tabulation, integration, and resultsNineteen studies with a total of 1843 patients with adenomyosis were included. Twelve studies were further analyzed in the meta-analysis. Complete excision of adenomyosis was associated with improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 6.2, 3.9, and 2.3, respectively; the partial excision of adenomyosis was associated with improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 5.9, 3.0, and 2.9, respectively; the studies with a mixed volume of patients with complete and partial excision of adenomyosis reported improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 4.0, 6.3, and 5.1, respectively.ConclusionThe surgical treatment of adenomyosis results in the satisfactory control of pain and bleeding, as well as in the reduction of uterine volume. Further research is warranted to investigate the long-term control of symptoms to identify any parameters related to the recurrence of adenomyosis, as well as to compare the conservative surgical treatment of adenomyosis with other treatment options.

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Condition tags

dysmenorrheaadenomyosis

MeSH descriptors

Adenomyosis Fertility Preservation Gynecologic Surgical Procedures Organ Sparing Treatments Adenomyosis Adenomyosis Adenomyosis Case-Control Studies Cohort Studies Dysmenorrhea Dysmenorrhea Dysmenorrhea Female Fertility Fertility Fertility Preservation Fertility Preservation Gynecologic Surgical Procedures Gynecologic Surgical Procedures Humans

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