title: Laparoscopic assisted adenomyomectomy using double flap method.
abstract: OBJECTIVE
  The purpose of this study was to evaluate postoperative prognosis and progression in patients who received laparoscopic-assisted adenomyomectomy using the double flap method.
  
  
  METHODS
  The pelvic cavity was explored by the conventional laparoscopic method, and drainage was achieved through a 5-mm trocar. After a small incision in the abdomen, the uterus was incised from the fundus to the upper cervical margin until exposing the endometrial cavity. Adenomyotic tissue was removed using a scalpel, scissors, or monopolar electrical bovie. The endometrial cavity was repaired with interrupted sutures using 2-0 vicryl. One side of the serosal flap was used to cover the endometrial side of the uterus. The second serosal flap covered the first flap after removal of the serosal surface of the first flap.
  
  
  RESULTS
  From January 2008 to March 2012, there were 11 cases of laparoscopic-assisted adenomyomectomy at Chungnam National University Hospital. Nine cases were analyzed, excluding two cases with less than one year of follow-up. The average patient age was 37.0 years and average follow-up duration was 32.8 months. All patients showed improvement in dysmenorrhea (P < 0.001) and hypermenorrhea (P = 0.001) after surgery and were evaluated by visual analogue scale score. However, symptoms of adenomyosis were aggravated in three patients. Adenomyosis was progressed in the side opposite the site of operation. One patient required a total laparoscopic hysterectomy 27 months after surgery.
  
  
  CONCLUSIONS
  Laparoscopic-assisted adenomyomectomy using the double flap method is effective for uterine reduction and relief of dysmenorrhea and hypermenorrhea. Conservative management and careful follow-up are needed because adenomyosis can recur or progress in some patients.
authors.affiliation: Department of Obstetrics and Gynecology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Jang-Kew
authors.initials: JK
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Chang-Soo
authors.initials: CS
authors.lastname: Shin
authors.affiliation: Department of Obstetrics and Gynecology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Young-Bok
authors.initials: YB
authors.lastname: Ko
authors.affiliation: Department of Obstetrics and Gynecology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Sang-Yun
authors.initials: SY
authors.lastname: Nam
authors.affiliation: Yim Hyun Sun Obstetrics and Gynecology Clinic, Daejeon, Korea.
authors.forename: Hyun-Sun
authors.initials: HS
authors.lastname: Yim
authors.affiliation: Department of Obstetrics and Gynecology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Ki-Hwan
authors.initials: KH
authors.lastname: Lee
keywords: Adenomyomectomy; Double-flap; Laparoscopy