<p>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</p>

Abstract

Purpose 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.

Laparoscopically assisted Adenomyomectomy Using the Double/Multiple-Flap Method with Temporary Occlusion of the Bilateral Uterine Artery and Utero-Ovarian Vessels in Comparison with the Double/Multiple-Flap Only Method

“…In our study, patients in both groups showed a lower rate of relapse (n = 1, 1.39% vs. n = 1, 1.35%) than previously reported (n = 32, 28.1%) 20 at the end of the 2-year follow-up period. These results are consistent with those reported previously by Zhu et al 22 . In our study, we found that the double/multiple-flap method could remove adenomyomatic lesions more radically and could reduce the risk of recurrence over time, at least theoretically.…”

“…The LNG-IUD releases 20 mg of levonorgestrel each day and represents an effective treatment for adenomyosis [21]. Zhu et al [22] further reported that the recurrence rate was significantly higher in patients who were only treated with GnRHa after surgery than in patients who were treated with GnRHa plus LNG-IUS after surgery (51.6 vs. 8.3 %; p < 0.05). In our study, patients in both groups showed a lower rate of relapse (n = 1, 1.39 % vs. n = 1, 1.35 %) than previously reported (n = 32, 28.1 %) [20] at the end of the 2-year follow-up period.…”

Laparoscopic adenomyomectomy combined with levonorgestrel‐releasing intrauterine system in the treatment of adenomyosis: Feasibility and effectiveness

“…It is reported that of those who received 6 courses of GnRH‐a after laparoscopic adenomyomectomy, 11.5% experienced relapse compared with 39.1% experienced relapse in the surgical‐only treatment group, 20 but with a high recurrence rate after drug discontinuation 21 . Zhu et al 22 . reported that significant differences of the recurrence rate were found between patients with adenomyosis who were only treated with GnRH‐a postoperatively and patients who were treated with GnRH‐a plus LNG‐IUS after surgery (33.3% vs 5.1%).…”

Characterisation of Microscopic Changes in Macroscopically Unaffected Peritoneum in Women with and without Endometriosis

“…The first case could explain why up to 50% of patients who underwent surgical EM resection, have a recurrence of complaints and "new" EM lesions within 5 years [24,25]. The opinion of Kahn et al that OME lesions are biologically active and have growth potential would support this theory [22].…”