Conservative surgery of uterine adenomyosis via laparoscopic versus laparotomic approach in a single institution

Jae Young Kwack, Kwack JY, Kyong Shil Im, Im KS, Kwon YS, Yong-Soon Kwon, Yong‐Soon Kwon
Journal of Obstetrics and Gynaecology Research · 2018 · vol. 44(7) , pp. 1268–1273 · doi:10.1111/jog.13658 · PMID:29845687 · W2806973644
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Laparoscopic conservative surgery for focal adenomyosis and laparotomy for diffuse adenomyosis demonstrated effectiveness in symptom reduction with differing operative times and blood loss.

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Abstract

AIMS: To evaluate the surgical outcomes of both approach methods (laparoscopy vs laparotomy) and to suggest the proper surgical approach according to type of uterine adenomyosis (focal vs diffuse). METHODS: We retrospectively analyzed 224 cases of uterine adenomyomectomy, 116 laparotomic and 108 laparoscopic, performed between July 2011 and June 2016 by a single surgeon (Y. S. K.). In all 224 cases, the surgeon had used transient occlusion of the uterine artery (TOUA). Surgical outcomes included weight of specimen, operating time, estimated blood loss and intraoperative injury to other organs. Postoperative clinical outcomes included symptom improvement (dysmenorrhea, menorrhagia and others) and recurrence. RESULTS: All patients in the laparoscopic group had been diagnosed with focal uterine adenomyosis, and most in the laparotomic group (85.3%) had been diagnosed with diffuse type. The largest lesion diameters were 6.48 cm in the laparotomic group and 4.34 cm in the laparotomic group. Operation time and estimated blood loss were 116.12 min and 222.67 mL in the laparotomic group and 75.09 min, respectively, and 155.33 mL in the laparoscopic group. There was no case of laparotomic conversion in patients with laparoscopic adenomyomectomy. CONCLUSION: Conservative surgery is effective to reduce the symptoms of adenomyosis regardless of approach method. For near-complete excision of adenomyosis, the diffuse type is recommended to be treated with laparotomic adenomyomectomy, and focal lesions less than 5 cm can be treated with laparoscopic conservative surgery.

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Condition tags

adenomyosisdysmenorrhea

MeSH descriptors

Adenomyosis Gynecologic Surgical Procedures Laparoscopy Laparotomy Outcome and Process Assessment, Health Care Outcome and Process Assessment, Health Care Adenomyosis Adenomyosis Adult Adult Female Female Gynecologic Surgical Procedures Gynecologic Surgical Procedures Humans Humans Laparoscopy Laparoscopy Laparotomy Laparotomy

Citation neighborhood (2-hop)

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References (16)

Cited by (21)

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