Focal and Diffuse Adenomyomectomy: A Systematic Review of Comparative Outcomes from Published Studies Including 3397 Patients

OBJECTIVE: To compare focal and diffuse adenomyomectomy in terms of clinical characteristics, surgical complexity, postoperative outcomes, and reproductive results. DATA SOURCE: PubMed/MEDLINE, Web of Science, and Embase databases were searched from inception to October 2025 using keywords including "adenomyosis," "adenomyomectomy," "focal adenomyosis," "diffuse adenomyosis," "laparoscopy," and "laparotomy." Reference lists of relevant publications were also screened to identify additional studies. METHODS OF STUDY SELECTION: Studies reporting clinical, surgical, or reproductive outcomes after adenomyomectomy for focal or diffuse adenomyosis were included. Data extraction was independently performed by two investigators. TABULATION, INTEGRATION, AND RESULTS: The initial search identified 129 articles. After screening, 43 studies were included in the comparative review. A total of 3397 patients were analyzed, including 1460 who underwent focal adenomyomectomy and 1937 who underwent diffuse adenomyomectomy. Dysmenorrhea and primary infertility were more frequent in patients with diffuse adenomyosis, whereas dyspareunia, chronic pelvic pain, and dyschezia were more common in the focal group. Laparoscopic surgery was more frequently performed for focal adenomyosis, whereas laparotomy was more often required for diffuse adenomyomectomy. Intraoperative blood loss and the weight of excised adenomyotic tissue were significantly greater in diffuse adenomyomectomy. Complete relief of dysmenorrhea and menorrhagia occurred more frequently after diffuse adenomyomectomy. Pregnancy, live birth, and term delivery rates were also higher following diffuse adenomyomectomy. Obstetric complications, including uterine rupture and postpartum hemorrhage, were comparable between the groups. CONCLUSION: Focal and diffuse adenomyomectomy represent two distinct surgical approaches reflecting different patterns of adenomyotic involvement and operative complexity. Focal adenomyomectomy is more often amenable to minimally invasive techniques and targeted excision of localized lesions. In contrast, diffuse adenomyomectomy is generally associated with more extensive surgery and complex uterine reconstruction and may be associated with greater symptom improvement and favorable reproductive outcomes, based on reported outcomes across studies. Despite differences in surgical complexity, obstetric outcomes following conception appear largely comparable between groups.