ABSTRACT
Adenomyosis, characterized by the invasion of endometrial glands and stroma in the uterine myometrium, is a common benign gynecologic disease. Adenomyosis causes menorrhagia, irregular bleeding, dysmenorrhea, infertility, and (in some cases) recurrent abortions. Conservative medical management is limited, and for those desirous of pregnancy, surgical excision by adenomyomectomy is an option. Judicious use of two-dimensional ultrasonography and magnetic resonance imaging helps to plan the adenomyomectomy. Adenomyomectomy is a cytoreductive surgery, and maximum tissue is excised through various methods, such as wedge resection, transverse H incision, and the triple-flap method. Laparoscopic adenomyomectomy has been shown to be effective with reduced morbidity and good outcomes. Various methods can be applied to reduce blood loss, such as use of vasopressin and ligation of uterine arteries before dissection. The postoperative pregnancy rate also varies between 17.5% and 72.7%. The risk of uterine rupture due to pregnancy, after removal of a uterine adenomyosis, is more than 1.0%. Rupture risk depends on the method of excision, the amount of removal, extent of defect, and method of closure. Good obliteration of the dead space with U-shaped sutures to approximate the edges is recommended. Adenomyomectomy is a feasible surgery with good preservation of fertility and outcomes.
