Conservative surgical treatment indications of adenomyosis in patients with infertility

C.A. Coroleucă, M. Cîrstoiu, C. Berceanu, D. Hudiță, C.A. Ionescu, M. Mitran, E. Brătilă

Rezumat: Adenomyosis is a benign gynecologic disease affecting women of reproductive age. It is characterized by the ectopic presence of endometrial tissue (endometrial glands and stroma) in the myometrium. The incidence of adenomyosis is considered to be 1% in the female population, and is found mainly in patients aged between 35 and 50 years old. Although it may be asymptomatic, clinical presentation of adenomyosis is composed of pelvic pain, dysmenorrhea, menometrorrhagia and infertility. This paper presents an analysis of adenomyosis surgical treatment options based on personal experience and a literature review. Surgery in adenomyosis associated with infertility is reserved to symptomatic adenomyosis and in cases of failure of assisted human reproduction techniques. For patients with adenomyos and infertility, the “uterine sparing” principle is recommended, with the excision of the adenomiotic lesions. This surgical technique is preffered than hysterectomy, considering a future pregnancy in patients with infertility. Classical surgical treatment for symptomatic adenomyosis is hysterectomy. Considering that a high proportion of patients with adenomyosis wish to preserve the reproductive function for a future pregnancy, the optimal surgical treatment is conservative, represented by abdominal or laparoscopic adenomyomectomy.
Cuvinte cheie: denomyosis, conservative surgical treatment, adenomyomectomy, laparoscopic adenomyomectomy, hysterectomy.