Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis.
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.
Nihon University School of Medicine, Obstetrics and Gynaecology, Tokyo 101-8309, Japan. h-osada@towako-kato.com
Hisao
H
Osada
Sherman
S
Silber
Toshiyuki
T
Kakinuma
Masaji
M
Nagaishi
Keiichi
K
Kato
Osamu
O
Kato
D004412:Dysmenorrhea / Q000517:prevention & control; D004714:Endometrial Hyperplasia / Q000503:physiopathology / Q000601:surgery*; D004715:Endometriosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000517:prevention & control*; D008595:Menorrhagia / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D019651:Plastic Surgery Procedures; D012008:Recurrence; D012720:Severity of Illness Index; D013524:Surgical Flaps; D014597:Uterine Rupture / Q000517:prevention & control; D014599:Uterus / Q000601:surgery*