Conservative Surgery in the Management of Adenomyosis

Masato Nishida
In: Journal of Gynecology and Obstetrics · 2019 · vol. 7(1) , pp. 8 · doi:10.11648/j.jgo.20190701.12 · W2916353293
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This study evaluated conservative surgical management of adenomyosis, finding it effective for focal and diffuse types, with significant improvements in dysmenorrhea and bleeding, and a notable pregnancy rate, although recurrence and uterine rupture were observed.

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This retrospective report described conservative adenomyomectomy in 1,780 women with uterine adenomyosis treated at a single institution since 2002, classifying disease by MRI pattern into focal, diffuse, or cystic types and using three corresponding surgical techniques. Across methods, excision of lesions was performed using a loop electrode high-frequency cutter, with median resected lesion weights of 94 g (focal), 150 g (diffuse), and 16 g (cystic). Dysmenorrhea visual analogue scores decreased from 9.1 to 1.0 and heavy menstrual bleeding improved, while 370 pregnancies occurred in 294 patients and 10.3% of 1,462 patients had recurrence after more than 2 years; uterine rupture was reported in 5 cases. The paper’s limitations include its single-institution, noncomparative design and reliance on reported outcomes without explicit control groups, which constrains causal interpretation. This paper does not explicitly discuss endometriosis or adenomyosis? It is centrally about adenomyosis—conservative adenomyomectomy outcomes—so it directly relates to adenomyosis.

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Abstract

Since 2002, we have performed adenomyomectomy for 1780 women with uterine adenomyosis. We classified adenomyosis in these patients as focal (n=1313), diffuse (n=450) or cystic (n=17) type according to the distribution of the focuses seen in magnetic resonance imaging (MRI) findings. Three different surgical methods for focal, diffuse and cystic adenomyosis are utilized at our institution. The adenomyosis lesion is excised using a loop electrode of a high-frequency cutter in all methods. The median resected lesion weight of focal, diffuse and cystic adenomyosis were 94 g (1-1156 g), 150 g (10-1595 g), and 16 g (3-45 g), respectively. The mean visual analogue score for dysmenorrhea decreased from 9.1 to 1.0 and heavy menstrual bleeding was improved in all cases. Following the procedure, 370 pregnancies occurred in 294 patients, of which 153 (41.9%) were the result of natural conception. Pregnancy rate of the patients younger than 40 years were 35.1% in focal type, 25.4% in diffuse type and 88.9% in cystic type. Among those patients, we experienced 5 cases of uterine rupture. Of 1462 patients who underwent surgery more than 2 years prior to the time of writing, recurrence occurred in 150 (10.3%). Our findings indicate that conservative surgery for uterine adenomyosis using a high-frequency resection device is effective for both focal and diffuse type.
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Abstract

Since 2002, we have performed adenomyomectomy for 1780 women with uterine adenomyosis. We classified adenomyosis in these patients as focal (n=1313), diffuse (n=450) or cystic (n=17) type according to the distribution of the focuses seen in magnetic resonance imaging (MRI) findings. Three different surgical methods for focal, diffuse and cystic adenomyosis are utilized at our institution. The adenomyosis lesion is excised using a loop electrode of a high-frequency cutter in all methods. The median resected lesion weight of focal, diffuse and cystic adenomyosis were 94 g (1-1156 g), 150 g (10-1595 g), and 16 g (3-45 g), respectively. The mean visual analogue score for dysmenorrhea decreased from 9.1 to 1.0 and heavy menstrual bleeding was improved in all cases. Following the procedure, 370 pregnancies occurred in 294 patients, of which 153 (41.9%) were the result of natural conception. Pregnancy rate of the patients younger than 40 years were 35.1% in focal type, 25.4% in diffuse type and 88.9% in cystic type. Among those patients, we experienced 5 cases of uterine rupture. Of 1462 patients who underwent surgery more than 2 years prior to the time of writing, recurrence occurred in 150 (10.3%). Our findings indicate that conservative surgery for uterine adenomyosis using a high-frequency resection device is effective for both focal and diffuse type. | Published in | Journal of Gynecology and Obstetrics (Volume 7, Issue 1) | | DOI | 10.11648/j.jgo.20190701.12 | | Page(s) | 8-16 | | Creative Commons | This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. | | Copyright | Copyright © The Author(s), 2019. Published by Science Publishing Group |

Keywords

Adenomyosis, Conservative Surgery, Classification, Prognosis, Pregnancy, Recurrence

References

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Ichikawa, Y. Kondo, H. Itagaki, and M. Sakanaka (2018) Uterine rupture during subsequent pregnancy following adenomyomectomy – Report of five cases and proposal of prevention.Int J Womens Health Wellness 4,70. doi: 10.23937/2474-1353/1510070. | Cite This Article - APA Style Masato Nishida, Hiroya Itagaki, Yasuo Otsubo, Yuko Arai. (2019). Conservative Surgery in the Management of Adenomyosis. Journal of Gynecology and Obstetrics, 7(1), 8-16. https://doi.org/10.11648/j.jgo.20190701.12 ACS Style Masato Nishida; Hiroya Itagaki; Yasuo Otsubo; Yuko Arai. Conservative Surgery in the Management of Adenomyosis. J. Gynecol. Obstet. 2019, 7(1), 8-16. doi: 10.11648/j.jgo.20190701.12 AMA Style Masato Nishida, Hiroya Itagaki, Yasuo Otsubo, Yuko Arai. Conservative Surgery in the Management of Adenomyosis. J Gynecol Obstet. 2019;7(1):8-16. doi: 10.11648/j.jgo.20190701.12 - @article{10.11648/j.jgo.20190701.12, author = {Masato Nishida and Hiroya Itagaki and Yasuo Otsubo and Yuko Arai}, title = {Conservative Surgery in the Management of Adenomyosis}, journal = {Journal of Gynecology and Obstetrics}, volume = {7}, number = {1}, pages = {8-16}, doi = {10.11648/j.jgo.20190701.12}, url = {https://doi.org/10.11648/j.jgo.20190701.12}, eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20190701.12}, abstract = {Since 2002, we have performed adenomyomectomy for 1780 women with uterine adenomyosis. We classified adenomyosis in these patients as focal (n=1313), diffuse (n=450) or cystic (n=17) type according to the distribution of the focuses seen in magnetic resonance imaging (MRI) findings. Three different surgical methods for focal, diffuse and cystic adenomyosis are utilized at our institution. The adenomyosis lesion is excised using a loop electrode of a high-frequency cutter in all methods. The median resected lesion weight of focal, diffuse and cystic adenomyosis were 94 g (1-1156 g), 150 g (10-1595 g), and 16 g (3-45 g), respectively. The mean visual analogue score for dysmenorrhea decreased from 9.1 to 1.0 and heavy menstrual bleeding was improved in all cases. Following the procedure, 370 pregnancies occurred in 294 patients, of which 153 (41.9%) were the result of natural conception. Pregnancy rate of the patients younger than 40 years were 35.1% in focal type, 25.4% in diffuse type and 88.9% in cystic type. Among those patients, we experienced 5 cases of uterine rupture. Of 1462 patients who underwent surgery more than 2 years prior to the time of writing, recurrence occurred in 150 (10.3%). Our findings indicate that conservative surgery for uterine adenomyosis using a high-frequency resection device is effective for both focal and diffuse type.}, year = {2019} } - TY - JOUR T1 - Conservative Surgery in the Management of Adenomyosis AU - Masato Nishida AU - Hiroya Itagaki AU - Yasuo Otsubo AU - Yuko Arai Y1 - 2019/02/28 PY - 2019 N1 - https://doi.org/10.11648/j.jgo.20190701.12 DO - 10.11648/j.jgo.20190701.12 T2 - Journal of Gynecology and Obstetrics JF - Journal of Gynecology and Obstetrics JO - Journal of Gynecology and Obstetrics SP - 8 EP - 16 PB - Science Publishing Group SN - 2376-7820 UR - https://doi.org/10.11648/j.jgo.20190701.12 AB - Since 2002, we have performed adenomyomectomy for 1780 women with uterine adenomyosis. We classified adenomyosis in these patients as focal (n=1313), diffuse (n=450) or cystic (n=17) type according to the distribution of the focuses seen in magnetic resonance imaging (MRI) findings. Three different surgical methods for focal, diffuse and cystic adenomyosis are utilized at our institution. The adenomyosis lesion is excised using a loop electrode of a high-frequency cutter in all methods. The median resected lesion weight of focal, diffuse and cystic adenomyosis were 94 g (1-1156 g), 150 g (10-1595 g), and 16 g (3-45 g), respectively. The mean visual analogue score for dysmenorrhea decreased from 9.1 to 1.0 and heavy menstrual bleeding was improved in all cases. Following the procedure, 370 pregnancies occurred in 294 patients, of which 153 (41.9%) were the result of natural conception. Pregnancy rate of the patients younger than 40 years were 35.1% in focal type, 25.4% in diffuse type and 88.9% in cystic type. Among those patients, we experienced 5 cases of uterine rupture. Of 1462 patients who underwent surgery more than 2 years prior to the time of writing, recurrence occurred in 150 (10.3%). Our findings indicate that conservative surgery for uterine adenomyosis using a high-frequency resection device is effective for both focal and diffuse type. VL - 7 IS - 1 ER - Author Information Copyright © 2012 -- 2026 Science Publishing Group – All rights reserved.

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