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

Journal of Pain Research Dovepress open access to scientific and medical research Journal of Pain Research downloaded from https://www.dovepress.com/ by 113.198.234.40 on 02-Jun-2020 For personal use only. Open Access Full Text Article ORIGINAL RESEARCH 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 This article was published in the following Dove Press journal: Journal of Pain Research Libo Zhu Shuyi Chen Xuan Che Ping Xu Xiufeng Huang Xinmei Zhang The Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, People’s Republic of China 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 postsurgically 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. Keywords: adenomyosis, adenomyomectomy, efficacy, recurrence, treatment Introduction Correspondence: Xinmei Zhang The Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, Zhejiang 310006, People’s Republic of China Tel +86 57 187 061 501 2131 Fax +86 5 718 706 1878 Email Adenomyosis, characterized by the invasion of endometrial glands and stroma in the uterine myometrium, is a common benign gynecologic disease. The main symptoms of adenomyosis are hypermenorrhea, dysmenorrhea, and subfertility.1,2 Moreover, adenomyosis may be associated with recurrent abortion, premature delivery, and complications of late pregnancy such as placenta previa.3–8 Drug therapy includes gonadotropin-releasing hormone agonists (GnRHa), oral contraceptive pills (OCs), submit your manuscript | www.dovepress.com Journal of Pain Research 2019:12 1917–1924 DovePress http://doi.org/10.2147/JPR.S205561 Powered by TCPDF (www.tcpdf.org) 1917 © 2019 Zhu et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Dovepress Journal of Pain Research downloaded from https://www.dovepress.com/ by 113.198.234.40 on 02-Jun-2020 For personal use only. Zhu et al levonorgestrel-releasing intrauterine devices (LNG-IUS or Mirena), high-dose progestins, danazol, aromatase inhibitors, and selective estrogen/progesterone receptor modulators can relieve symptoms effectively,9–11 but these drugs are only temporary, and pregnancy is not possible during drug therapy. In addition, some patients are refractory to drug therapy. Although high intensity focused ultrasound (HIFU) and uterine arterial embolization (UAE) are both effective in the treatment of adenomyosis, yet, the therapeutic effects of these two techniques on adenomyosis still remain to be further investigated.12–16 As a matter of fact, only total hysterectomy can thoroughly treat adenomyosis. Recently, the trend of uterus-sparing surgery in the treatment of adenomyosis has been gradually increasing with the delay of women’s childbearing age and their strong desire to retain uterus. For focal uterine adenomyosis, such as adenomyoma and cystic adenomyosis, the surgical procedure of adenomyomectomy for adenomyosis is relatively simple, which is the same as myomectomy for uterine leiomyoma.17 However, for diffuse uterine adenomyosis, the surgical procedure of adenomyomectomy for adenomyosis is always difficult, because diffuse uterine adenomyosis involves the entire myometrium or more than half of the total myometrium.18–20 Obviously, conservative surgery for diffuse uterine adenomyosis is only the partial resection of adenomyosis.21 Currently, many resection methods of uterus-sparing surgery have been demonstrated to treat diffuse uterine adenomyosis effectively, but only the triple-flap adenomyomectomy can almost completely remove the lesions of diffuse uterine adenomyosis.22 In our previous study, we modified the technique of the triple-flap method to perform laparoscopic double-flap adenomyomectomy in the treatment of uterine diffuse adenomyosis.1 Our previous results showed that laparoscopic double-flap adenomyomectomy can effectively treat severe diffuse uterine adenomyosis in a short time.1 However, the long-term efficacy and the surgical modes of adenomyomectomy are still debated. The objective of our present study was to evaluate the long-term outcomes of laparoscopic doubleflap adenomyomectomy in the treatment of severe uterine diffuse adenomyosis and compare the efficacy of adenomyomectomy via laparoscopy and laparotomy in the treatment of severe diffuse uterine adenomyosis. Patients and methods Patients The study was approved by the Ethics Committee of Women’s Hospital, Zhejiang University School of Medicine in accordance 1918 Powered by T (...truncated)