Comparisons of the efficacy and recurrence of adenomyomectomy for severe uterine diffuse adenomyosis via laparotomy versus laparoscopy: a long-term result in a single institution

Liping Zhu; S Chen; Xin Che; Ping Xu; Xiande Huang; X Zhang

Comparisons of the efficacy and recurrence of adenomyomectomy for severe uterine diffuse adenomyosis via laparotomy versus laparoscopy: a long-term result in a single institution

Liping Zhu, S Chen, Xin Che, Ping Xu, Xiande Huang, X Zhang

In: Journal of Pain Research, Vol Volume 12, Pp 1917-1924 (2019) · 2019 · W4380074727

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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study compared long-term adenomyomectomy efficacy and recurrence rates for severe diffuse adenomyosis between laparotomy and laparoscopy, finding laparotomy potentially superior though not statistically significant, with recurrence influenced by postoperative medication and endometriosis presence.

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This single-institution retrospective study compared long-term efficacy and recurrence after double-flap adenomyomectomy performed via laparotomy versus laparoscopy in 148 women with severe diffuse uterine adenomyosis (laparoscopic n=72; laparotomic n=76), with outcomes assessed at up to 6 years. The 6-year effective rate was higher for laparotomy (75.0%) than laparoscopy (62.1%), while the 6-year cumulative recurrence rate was higher for laparoscopy (27.8% vs 17.1%), but neither difference reached statistical significance. Within both groups, recurrence was lower in patients receiving combined postoperative hormonal management (GnRHa plus Mirena or oral contraceptives) compared with GnRHa alone, and recurrence was higher among adenomyosis patients with concomitant endometriosis than those without. This paper is centrally about adenomyosis — it evaluates long-term outcomes and recurrence factors after different surgical approaches to adenomyomectomy, including effects related to comorbid endometriosis.

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Abstract

Libo Zhu, Shuyi Chen, Xuan Che, Ping Xu, Xiufeng Huang, Xinmei ZhangThe Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, People’s Republic of ChinaPurpose: Studies have shown that adenomyomectomy can effectively treat women with adenomyosis in a short period of time. However, the long-term efficacy of adenomyomectomy has rarely been reported. The objective of this study was to determine whether laparotomy is superior to laparoscopic surgery in the long-term efficacy of double-flap method adenomyomectomy for severe diffuse adenomyosis.Methods: Between March 2011 and September 2018, a total of 148 patients with severe uterine diffuse adenomyosis who underwent laparoscopic (group A, n=72) and laparotomic (group B, n=76) double-flap adenomyomectomy were recruited. Adenomyomectomy efficacy and adenomyosis recurrence after surgery between groups A and B were comparatively analyzed.Results: The effective rate at 6-year follow up after surgery was higher in group B (75.0%) than that in group A (62.1%), while the 6-year cumulative recurrence rate was higher in group A (27.8%) than that in group B (17.1%), but the differences did not reach statistical significance between the two groups (P>0.05). The recurrence rate was lower in patients who were treated with gonadotropin-releasing hormone agonist (GnRHa) plus Mirena or oral contraceptives post-surgically than that in patients who were treated with only GnRHa post-surgically in groups A (51.6% vs 9.8%, P<0.01) and B (33.3% vs 6.5%, P<0.05). Moreover, the recurrence rate of adenomyosis patients with endometriosis was higher than that of adenomyosis patients without endometriosis in group A (55.0% vs 17.3%, P<0.05) and group B (36.0% vs 7.8%, P<0.05).Conclusion: The long-term outcomes of laparoscopic and laparotomic double-flap adenomyomectomy can be achieved for severe diffuse uterine adenomyosis, but laparotomy seems to have advantages over laparoscopy. Postoperative drug use may be beneficial to reduce the recurrence of adenomyosis, especially for adenomyosis with endometriosis.Keywords: adenomyosis, adenomyomectomy, efficacy, recurrence, treatment

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Journal of Pain Research (Jun 2019) Comparisons of the efficacy and recurrence of adenomyomectomy for severe uterine diffuse adenomyosis via laparotomy versus laparoscopy: a long-term result in a single institution Abstract Libo Zhu, Shuyi Chen, Xuan Che, Ping Xu, Xiufeng Huang, Xinmei ZhangThe Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, People’s Republic of ChinaPurpose: Studies have shown that adenomyomectomy can effectively treat women with adenomyosis in a short period of time. However, the long-term efficacy of adenomyomectomy has rarely been reported. The objective of this study was to determine whether laparotomy is superior to laparoscopic surgery in the long-term efficacy of double-flap method adenomyomectomy for severe diffuse adenomyosis.Methods: Between March 2011 and September 2018, a total of 148 patients with severe uterine diffuse adenomyosis who underwent laparoscopic (group A, n=72) and laparotomic (group B, n=76) double-flap adenomyomectomy were recruited. Adenomyomectomy efficacy and adenomyosis recurrence after surgery between groups A and B were comparatively analyzed.Results: The effective rate at 6-year follow up after surgery was higher in group B (75.0%) than that in group A (62.1%), while the 6-year cumulative recurrence rate was higher in group A (27.8%) than that in group B (17.1%), but the differences did not reach statistical significance between the two groups (P>0.05). The recurrence rate was lower in patients who were treated with gonadotropin-releasing hormone agonist (GnRHa) plus Mirena or oral contraceptives post-surgically than that in patients who were treated with only GnRHa post-surgically in groups A (51.6% vs 9.8%, P<0.01) and B (33.3% vs 6.5%, P<0.05). Moreover, the recurrence rate of adenomyosis patients with endometriosis was higher than that of adenomyosis patients without endometriosis in group A (55.0% vs 17.3%, P<0.05) and group B (36.0% vs 7.8%, P<0.05).Conclusion: The long-term outcomes of laparoscopic and laparotomic double-flap adenomyomectomy can be achieved for severe diffuse uterine adenomyosis, but laparotomy seems to have advantages over laparoscopy. Postoperative drug use may be beneficial to reduce the recurrence of adenomyosis, especially for adenomyosis with endometriosis.Keywords: adenomyosis, adenomyomectomy, efficacy, recurrence, treatment

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