Combined modified two-stage Osada-Strassmann surgery in a patient with severe concurrent pathology (a complete bicornuate uterus, diffusive adenomyosis, and deep infiltrating endometriosis)


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Abstract

Background: Young patients with a concurrence of various severe gynecological diseases are now increasingly being observed in the practice of an obstetrician/gynecologist. The treatment of these women, primarily surgical treatment, presents a significant challenge due to the need to preserve reproductive function. Case report: The paper presents the authors’ clinical observation of successful two-stage surgery in a young patient with complex concurrent pathology: grade 3 diffuse adenomyosis; infiltrating endometriosis of the uterovesical fold, retrocervical endometriosis, complete bicornuate uterus (uterus bicornis bicollis), and primary infertility. During the laparoscopic stage, endometriosis focus removal, adhesiolysis, and bilateral tubectomy were done; during the laparotomic stage, adenomyomectomy for severe diffuse adenomyosis using the method of H. Osada in each of the uterus, subsequent metroplasty, and creation of a single uterus by the modified Strassmann method, by taking into account the individual characteristics of a patient and the presence of complex concurrent pathology. Conclusion: Severe concurrent gynecological pathology required surgical treatment consisting of several stages. The performed operation was not just a combination of two techniques, but also needed a particular modification in terms of the individual characteristics of a patient and the presence of complex concurrent pathology. The surgical treatment restored the normal anatomy of the internal genital organs, which leaves the patient with a chance to realize her reproductive function.

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About the authors

Vitaly B. Tskhay

Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia; Federal Siberian Research and Clinical Center, Federal Biomedical Agency

Email: tchai@yandex.ru
Dr. Med. Sci., Professor, Head of the Department of Perinatology, Obstetrics and Gynecology

Gulnar Telman kyzy Mikailly

Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia; Territorial Regional Center for Maternal and Child Care

Email: miktsgm@mail.ru
Assistant of the Department of Perinatology, Obstetrics and Gynecology

Alla A. Andreeva

Territorial Regional Center for Maternal and Child Care

Email: alla.andreeva.20l2@bk.ru
Head of the Gynecological Department

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