Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis

Abstract

The treatment for severe adenomyosis has usually been hysterectomy, because there is no line of demarcation between diseased and normal tissue. Yet many such women wish to retain their uterus and some even wish to bear children. This report evaluates the efficacy of a new method of adenomyomectomy, where adenomyotic tissues are radically excised and the uterine wall is reconstructed by a triple-flap method, without overlapping suture lines, to prevent uterine rupture in subsequent pregnancies. This is a prospective case series followed for 10 years from June 1998 to August 2008 of 104 women with severe adenomyosis verified histologically and with magnetic resonance imaging. There was a dramatic reduction in both dysmenorrhoea and hypermenorrhoea and all patients returned to having normal menstrual cycles. Of 26 women who wished to conceive, 16 became pregnant, 14 (53.8%)went to term and delivered a healthy baby and there were no cases of uterine rupture. Adenomyosis symptoms recurred in only four out of 104 cases. The procedure thus resulted in a dramatic reduction in symptoms and allowed over half of women who wished to conceive to go to term without uterine rupture.

Complications and outcomes of pregnant women with adenomyosis in Japan

“…25,26 The present results show an increase in the incidence of intrauterine infection . [27][28][29][30] In the present study, there were no data to suggest that conservative surgery as a pretreatment for adenomyosis before pregnancy reduced the incidence of pregnancy complications. However, as the surgical techniques differed by facility, it is difficult to analyze the association between the pregnancy outcomes and the individual surgical techniques.…”

Adenomyosis and infertility

“…A new conservative technique to be employed in women with adenomyosis wishing to become pregnant has just been published (Osada et al, 2011). Indications for surgery were based on size and extent of lesions.…”

A case report of a successful live birth following IVF preceded by fertility sparing surgery for a large adenomyomata

“…A recent study by Osada et al (2011) reported 45 patients with large adenomyosis who had IVF treatment before attempting cytoreductive surgery. A total of 17 patients (37.8%) conceived, only to miscarry in the 1st trimester (longest 14 weeks).…”

“…Th e third and most recent case series (Osada et al 2011), included a prospective 104 patients over a 10-year period. Following surgery, 26 patients wished to conceive.…”