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Surgery in adenomyosis

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Abstract

Introduction

Adenomyosis is defined as the presence of endometrial glands and stroma within the myometrium. The true prevalence is unknown and has been reported to range from 1 to 70%. It has a significantly negative impact on women’s quality of life, causing abnormal uterine bleeding, dysmenorrhea, and chronic pelvic pain. The definitive treatment for adenomyosis is hysterectomy, although it does not contemplate patients who wish to preserve their fertility. The aim of this paper is to discuss the latest evidence on the surgical techniques for the treatment of adenomyosis published in medical–scientific databases.

Method

A comprehensive literature search for articles published from 1996 to 2017 related to surgery for adenomyosis was made in Pubmed, Medline, the Cochrane Library, and Google Scholar, in English, by the following MeSH terms: adenomyosis, surgery, pathogenesis, dysmenorrhea and infertility.

Results

There is extensive evidence on several surgical approaches for the improvement of adenomyosis-related symptoms; however, there is no robust evidence that they are effective for infertility.

Conclusion

The management of adenomyosis is quite complex and controversial. Complications after extensive uterine reconstruction, such as uterine rupture, should be considered and discussed with the patient. There are still limited data to support surgery effectiveness, especially for infertility, and further well-designed studies are required.

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Fig. 1
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(courtesy of Oliveira, MAP)

Fig. 3

(courtesy of Oliveira, MAP)

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References

  1. Abbott JA (2017) Adenomyosis and abnormal uterine bleeding (AUB-A)—pathogenesis, diagnosis, and management. Best Pract Res Clin Obstet Gynaecol 40:68–81

    Article  PubMed  Google Scholar 

  2. Alabiso G, Alio L, Arena S, Barbasetti di Prun A, Bergamini V, Berlanda N et al (2016) Adenomyosis: what the patient needs. J Minim Invasive Gynecol. 23(4):476–488

    Article  PubMed  Google Scholar 

  3. Benagiano G, Brosens I, Habiba M (2015) Adenomyosis: a life-cycle approach. Reprod Biomed Online 30(3):220–232

    Article  CAS  PubMed  Google Scholar 

  4. Berner E, Qvigstad E, Myrvold AK, Lieng M (2014) Pelvic pain and patient satisfaction after laparoscopic supracervical hysterectomy: prospective trial. J Minim Invasive Gynecol 21(3):406–411

    Article  PubMed  Google Scholar 

  5. Campo S, Campo V, Benagiano G (2012) Adenomyosis and infertility. Reprod Biomed Online 24(1):35–46

    Article  PubMed  Google Scholar 

  6. Dasrilsyah RA, Shan LP, Kwang NB, Shafiee MN, Omar MH (2016) Spontaneous conception following GnRHa and progestogen therapy in adenomyosis. Horm Mol Biol Clin Investig 27(2):77–79

    CAS  PubMed  Google Scholar 

  7. Di Donato N, Montanari G, Benfenati A, Leonardi D, Bertoldo V, Monti G et al (2014) Prevalence of adenomyosis in women undergoing surgery for endometriosis. Eur J Obstet Gynecol Reprod Biol 181:289–293

    Article  PubMed  Google Scholar 

  8. Farquhar C, Brosens I (2006) Medical and surgical management of adenomyosis. Best Pract Res Clin Obstet Gynaecol 20(4):603–616

    Article  PubMed  Google Scholar 

  9. Ferrari F, Arrigoni F, Miccoli A, Mascaretti S, Fascetti E, Mascaretti G (2016) Effectiveness of Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) in the uterine adenomyosis treatment: technical approach and MRI evaluation. Radiol Med 121(2):153–161

    Article  PubMed  Google Scholar 

  10. Fujishita A, Masuzaki H, Khan KN, Kitajima M, Ishimaru T (2004) Modified reduction surgery for adenomyosis: a preliminary report of the transverse H incision technique. Gynecol Obstet Invest 57:132–138

    Article  PubMed  Google Scholar 

  11. Furuhashi M, Miyabe Y, Katsumata Y, Oda H, Imai N (1998) Comparison of complications of vaginal hysterectomy in patients with leiomyomas and in patients with adenomyosis. Arch Gynecol Obstet 262(1–2):69–73

    Article  CAS  PubMed  Google Scholar 

  12. Genc M, Genc B, Cengiz H (2015) Adenomyosis and accompanying gynecological pathologies. Arch Gynecol Obstet. 291(4):877–881

    Article  PubMed  Google Scholar 

  13. Grimbizis GF, Mikos T, Tarlatzis B (2014) Uterus-sparing operative treatment for adenomyosis. Fertil Steril 101(2):472–487

    Article  PubMed  Google Scholar 

  14. Grimbizis GF, Mikos T, Zepiridis L, Theodoridis T, Miliaras D, Tarlatzis BC, Bontis JN (2008) Laparoscopic excision of uterine adenomyomas. Fertil Steril 89(4):953–961

    Article  PubMed  Google Scholar 

  15. Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F (2016) The impact of adenomyosis on women’s fertility. Obstet Gynecol Surv 71(9):557–568

    Article  PubMed  PubMed Central  Google Scholar 

  16. Horng HC, Chen CH, Chen CY, Tsui KH, Liu WM, Wang PH (2014) Uterine-sparing surgery for adenomyosis and/or adenomyoma. Taiwan J Obstet Gynecol 53(1):3–7

    Article  PubMed  Google Scholar 

  17. Huang X, Huang Q, Chen S, Zhang J, Lin K, Zhang X (2015) Efficacy of laparoscopic adenomyomectomy using double-flap method for diffuse uterine adenomyosis. BMC Womens Health 15:24

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hyams LL (1952) Adenomyosis, its conservative surgical treatment (hysteroplasty) in young women. NY State J Med 52:2778–2784

    CAS  Google Scholar 

  19. Kang L, Gong J, Cheng Z, Dai H, Liping H (2009) Clinical application and midterm results of laparoscopic partial resection of symptomatic adenomyosis combined with uterine artery occlusion. J Minim Invasive Gynecol 16:169–173

    Article  PubMed  Google Scholar 

  20. Kim TJ, Shin SJ, Kim TH, Cho CH, Kwon SH, Seong SJ et al (2015) Multi-institution, prospective, randomized trial to compare the success rates of single-port versus multiport laparoscopic hysterectomy for the treatment of uterine myoma or adenomyosis. J Minim Invasive Gynecol 22(5):785–791

    Article  PubMed  Google Scholar 

  21. Kishi Y, Yabuta M, Taniguchi F (2014) Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility? Fertil Steril 102(3):802.e1–807.e1

    Article  Google Scholar 

  22. Kwack JY, Jeon SB, Kim K, Lee SJ, Kwon YS (2016) Monochorionic twin delivery after conservative surgical treatment of a patient with severe diffuse uterine adenomyosis without uterine rupture. Obstet Gynecol Sci 59(4):311–315

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kwon YS, Roh HJ, Ahn JW, Lee SH, Im KS (2015) Conservative adenomyomectomy with transient occlusion of uterine arteries for diffuse uterine adenomyosis. J Obstet Gynaecol Res 41(6):938–945

    Article  PubMed  Google Scholar 

  24. Laganà AS, Vitale SG, Salmeri FM, Triolo O, Ban Frangež H, Vrtačnik-Bokal E et al (2017) Unus pro omnibus, omnes pro uno: a novel, evidence-based, unifying theory for the pathogenesis of endometriosis. Med Hypotheses 103:10–20

    Article  PubMed  Google Scholar 

  25. Lieng M, Qvigstad E, Istre O, Langebrekke A, Ballard K (2008) Long-term outcomes following laparoscopic supracervical hysterectomy. BJOG 115:1605–1610

    Article  CAS  PubMed  Google Scholar 

  26. Morita M, Asakawa Y, Nakakuma M, Kubo H (2004) Laparoscopic excision of myometrial adenomyomas in patients with adenomyosis uteri and main symptoms of severe dysmenorrhea and hypermenorrhea. J Am Assoc Gynecol Laparosc 11(1):86–89

    Article  PubMed  Google Scholar 

  27. Nezhat CH, Nezhat F, Roemisch M, Seidman DS, Nezhat C (1996) Laparoscopic trachelectomy for persistent pelvic pain and endometriosis after supracervical hysterectomy. Fertil Steril 66(6):925–928

    Article  CAS  PubMed  Google Scholar 

  28. Nishida M, Takano K, Arai Y, Ozone H, Ichikawa R (2010) Conservative surgical management for diffuse uterine adenomyosis. Fertil Steril 94:715–719

    Article  PubMed  Google Scholar 

  29. Osada H, Silber S, Kakinuma T, Nagaishi M, Kato K, Kato O (2011) Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod Biomed Online 22:94–99

    Article  PubMed  Google Scholar 

  30. Otsubo Y, Nishida M, Arai Y, Ichikawa R, Taneichi A, Sakanaka M (2016) Association of uterine wall thickness with pregnancy outcome following uterine-sparing surgery for diffuse uterine adenomyosis. Aust N Z J Obstet Gynaecol. 56(1):88–91

    Article  PubMed  Google Scholar 

  31. Pepas L, Deguara C, Davis C (2012) Update on the surgical management of adenomyosis. Curr Opin Obstet Gynecol 24(4):259–264

    Article  PubMed  Google Scholar 

  32. Phillips DR, Nathanson HG, Milim SJ, Haselkorn JS (1996) Laparoscopic bipolar coagulation for the conservative treatment of adenomyomata. J Am Assoc Gynecol Laparosc 4:19–24

    Article  CAS  PubMed  Google Scholar 

  33. Pontis A, D’Alterio MN, Pirarba S, de Angelis C, Tinelli R, Angioni S (2016) Adenomyosis: a systematic review of medical treatment. Gynecol Endocrinol 32(9):696–700

    Article  CAS  PubMed  Google Scholar 

  34. Saremi A, Bahrami H, Salehian P, Hakak N, Pooladi A (2014) Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique. Reprod Biomed Online 28(6):753–760

    Article  PubMed  Google Scholar 

  35. Scarperi S, Pontrelli G, Campana C, Steinkasserer M, Ercoli A, Minelli L, Bergamini V, Ceccaroni M (2015) Laparoscopic radiofrequency thermal ablation for uterine adenomyosis. JSLS. 19(4):e2015

    Article  PubMed  PubMed Central  Google Scholar 

  36. Streuli I, Dubuisson J, Santulli P, de Ziegler D, Batteux F, Chapron C (2014) An update on the pharmacological management of adenomyosis. Expert Opin Pharmacother 15(16):2347–2360

    Article  CAS  PubMed  Google Scholar 

  37. Struble J, Reid S, Bedaiwy MA (2016) Adenomyosis: a clinical review of a challenging gynecologic condition. J Minim Invasive Gynecol 23(2):164–185

    Article  PubMed  Google Scholar 

  38. Sun AJ, Luo M, Wang W, Chen R, Lang JH (2011) Characteristics and efficacy of modified adenomyomectomy in the treatment of uterine adenomyoma. Chin Med J (Engl) 124:1322–1326

    Google Scholar 

  39. Takeuchi H, Kitade M, Kikuchi I, Kumakiri J, Kuroda K, Jinushi M (2010) Diagnosis, laparoscopic management, and histopathologic findings of juvenile cystic adenomyoma: a review of nine cases. Fertil Steril 94:862–868

    Article  PubMed  Google Scholar 

  40. Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Kumakiri J, Kitano T et al (2006) Laparoscopic adenomyomectomy and hysteroplasty: a novel method. J Minim Invasive Gynecol 13:150–154

    Article  PubMed  Google Scholar 

  41. Taran FA, Stewart EA, Brucker S (2013) Adenomyosis: epidemiology, risk factors, clinical phenotype and surgical and interventional alternatives to hysterectomy. Geburtshilfe Frauenheilkd 73(9):924–931

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Tsui KH, Lee FK, Seow KM, Chang WC, Wang JW, Chen SU et al (2015) Conservative surgical treatment of adenomyosis to improve fertility: controversial values, indications, complications, and pregnancy outcomes. Taiwan J Obstet Gynecol 54(6):635–640

    Article  PubMed  Google Scholar 

  43. Vannuccini S, Tosti C, Carmona F, Huang SJ, Chapron C, Guo SW et al (2017) Pathogenesis of adenomyosis: an update on molecular mechanisms. Reprod Biomed Online 35(5):592–601

    Article  CAS  PubMed  Google Scholar 

  44. Vetvicka V, Laganà AS, Salmeri FM, Triolo O, Palmara VI, Vitale SG et al (2016) Regulation of apoptotic pathways during endometriosis: from the molecular basis to the future perspectives. Arch Gynecol Obstet 294(5):897–904

    Article  CAS  PubMed  Google Scholar 

  45. Wang PH, Fuh JL, Chao HT, Liu WM, Cheng MH, Chao KC (2009) Is the surgical approach beneficial to subfertile women with symptomatic extensive adenomyosis? J Obstet Gynaecol Res 35(3):495–502

    Article  PubMed  Google Scholar 

  46. Wattiez A, Cohen SB, Selvaggi L (2002) Laparoscopic hysterectomy. Curr Opin Obstet Gynecol 14:417–422

    Article  PubMed  Google Scholar 

  47. Yavuzcan A, Başbuğ A, Baştan M, Çağlar M, Özdemir İ (2016) The effect of adenomyosis on the outcomes of laparoscopic hysterectomy. J Turk Ger Gynecol Assoc 17(3):150–154

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Gynecology, State University of Rio de Janeiro, Rio de Janeiro, Brazil

    Marco Aurelio Pinho Oliveira & Leila Cristina Brollo

  2. Crispi Institute of Minimally Invasive Surgery, Rio de Janeiro, Brazil

    Claudio Peixoto Crispi Jr. & Claudio Peixoto Crispi

  3. Clinic of Gynecology, Obstetrics and Gynecological Oncology, Pius Hospital, University Hospital for Gynecology, Carl von Ossietzky University Medical School, Oldenburg, Germany

    Rudy Leon De Wilde

  4. Rua Dois de Dezembro 78/803, Flamengo, Rio de Janeiro, Brazil

    Marco Aurelio Pinho Oliveira

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  1. Marco Aurelio Pinho Oliveira
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  2. Claudio Peixoto Crispi Jr.
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  3. Leila Cristina Brollo
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MAPO: Project development, manuscript writing. CPCJ: Project development, manuscript writing. CPC: Manuscript editing. LCS: Manuscript editing. RLDW: Project development, manuscript reviewing. We confirm that the manuscript has been written and approved by all named authors.

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Correspondence to Marco Aurelio Pinho Oliveira.

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All authors declare that they do not have any potential conflict of interest relevant to this article.

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No external funding was involved during this analysis.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Oliveira, M.A.P., Crispi, C.P., Brollo, L.C. et al. Surgery in adenomyosis. Arch Gynecol Obstet 297, 581–589 (2018). https://doi.org/10.1007/s00404-017-4603-6

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  • DOI: https://doi.org/10.1007/s00404-017-4603-6

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