Experience with surgery for adenomyosis and assessment of reproductive outcomes

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Abstract

Adenomyosis is a variety of the benign pathological process, in which tissue in endometriosis affects the muscular layer of the uterus. The main principle of surgical intervention is the removal of myometrial tissue with invasion of endometriosis. The prevalence of adenomyosis ranges from 5 to 70%. The disease affects 2 in 10 women under the age of 40 years, while the incidence rises to 8 in 10 women between the ages of 40 and 50 years. However, the incidence of adenomyosis is difficult to determine due to the lack of a unified definition and diagnostic criteria based on noninvasive diagnostic methods. Its detection rate in the population varies from 10 to 61% according to different authors.

This paper presents surgical procedures for adenomyosis excision in the patient to perform her further reproductive function. Since 2012, by using the procedure described by H. Osada, the researchers (Prof. V.B. Tskhay and T.A. Makarenko, MD) of the Department of Obstetrics, Krasnoyarsk State Medical University, have been performing surgical interventions for excision of adenomyosis in patients with its diffuse forms and uterine sizes at 10 to 22 weeks’ gestation. The authors have also shown an original approach to suturing the uterus during surgery. The researchers (Prof. N.N. Rukhlyada and K.Yu. Krylov, PhD) of the Department of Obstetrics and Gynecology, Saint Petersburg State Pediatric Medical University, did 242 operations, of which 172 were performed to restore fertility; moreover, the total number of pregnancies that had occurred was 74 (43.1% or 30.5% of all the interventions).

Conclusion: Considering our experience of surgical interventions by laparotomy, we can conclude that there is no unified technique for the surgical treatment of adenomyosis – the choice of incisions and the way of suturing the myometrium depend both on the size of the uterus and on the location of the affected myometrium, its symmetry and uniformity, as well as on the volume of remaining intact tissue and the form of the defect.

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About the authors

Vitaliy F. Bezhenar

Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Author for correspondence.
Email: bez-vitaly@yandex.ru
ORCID iD: 0000-0002-7807-4929

Dr. Med. Sci., Professor, Head of the Department of Obstetrics, Gynecology and Neonatology/Obstetrics, Gynecology and Reproductology; Chief Freelance Specialist obstetrician-gynecologist of the Health Committee of the Government of St. Petersburg

Russian Federation, Saint Petersburg

Kirill Yu. Krylov

I.I. Dzhanelidze Saint Petersburg Research Institute of Emergence Care

Email: drkrylov@mail.ru
ORCID iD: 0000-0003-2149-5957

PhD, obstetrician-gynecologist, Senior Researcher at the Department of Gynecology

Russian Federation, Saint Petersburg

Tatyana A. Makarenko

V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia

Email: makarenko7777@yandex.ru

Dr. Med. Sci., Associate Professor, Head of the Department of Operative Gynecology, Institute of Postgraduate Education

Russian Federation, Krasnoyarsk

Valeriy I. Matukhin

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: val-matukhin@mail.ru
ORCID iD: 0000-0002-8906-8356

Assistant at the Department of Obstetrics and Gynecology

Russian Federation, Saint Petersburg

Nikolai N. Rukhliada

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia; I.I. Dzhanelidze Saint Petersburg Research Institute of Emergence Care

Email: nickolasr@mail.ru
ORCID iD: 0000-0002-3548-0468

Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology

Russian Federation, Saint Petersburg; Saint Petersburg

Vitaly B. Tskhay

V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia

Email: tchai@yandex.ru

Dr. Med. Sci., Professor, Head of the Department of Perinatology, Obstetrics and Gynecology; Scientific Supervisor in Obstetrics and Gynecology

Russian Federation, Krasnoyarsk

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2. Figure 1. Fertility after adenomyomectomy. general data of the authors (Prof. Tskhai V.B. et al., Prof. Rukhlyada N.N. et al., Prof. Bezhenar V.F. et al.)

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3. Figure 2. Dynamics of changes in the volume of the uterus in patients with adenomyosis in the postoperative period (in cm3)

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