Volume 7, Issue 1, January 2019, Page: 8-16
Conservative Surgery in the Management of Adenomyosis
Masato Nishida, Department of Obstetrics and Gynecology, National Hospital Organization, Kasumigaura Medical Center, Tsuchiura, Japan
Hiroya Itagaki, Department of Obstetrics and Gynecology, National Hospital Organization, Kasumigaura Medical Center, Tsuchiura, Japan
Yasuo Otsubo, Department of Obstetrics and Gynecology, National Hospital Organization, Kasumigaura Medical Center, Tsuchiura, Japan
Yuko Arai, Department of Obstetrics and Gynecology, National Hospital Organization, Kasumigaura Medical Center, Tsuchiura, Japan
Received: Dec. 29, 2018;       Accepted: Feb. 11, 2019;       Published: Feb. 28, 2019
DOI: 10.11648/j.jgo.20190701.12      View  27      Downloads  19
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.
Adenomyosis, Conservative Surgery, Classification, Prognosis, Pregnancy, Recurrence
To cite this article
Masato Nishida, Hiroya Itagaki, Yasuo Otsubo, Yuko Arai, Conservative Surgery in the Management of Adenomyosis, Journal of Gynecology and Obstetrics. Vol. 7, No. 1, 2019, pp. 8-16. doi: 10.11648/j.jgo.20190701.12
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This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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