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Efficacy of laparoscopic adenomyomectomy using double-flap method for diffuse uterine adenomyosis.

Huang X, Huang Q, Chen S, Zhang J, Lin K, Zhang X - BMC Womens Health (2015)

Bottom Line: The VAS scores, menstrual amount, serum CA125 levels, and uterine volume at 12 or 24 months after surgery significantly reduced in group B than in group A (P < 0.05); these parameters were statistically decreased in both groups after surgery compared with those obtained before surgery (P < 0.001).Moreover, serum CA125 levels and uterine volume at six months of follow up were significantly lower in group B than in group A (P < 0.01).In addition, blood loss during surgery was similar in groups A and B (P > 0.05), although the operative time was significantly longer in group B than that in group A (P < 0.05).

View Article: PubMed Central - PubMed

Affiliation: The Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, 1 Xueshi Road, Hangzhou, Zhejiang, 310006, P. R. China, huangxiufeng73@163.com.

ABSTRACT

Background: Adenomyomectomy has recently been considered the priority option for the treatment of adenomyosis, however, the surgical efficacy and modes are still debated. We aimed to evaluate the efficacy of laparoscopic adenomyomectomy using a double-flap method for the treatment of uterine diffuse adenomyosis when compared with conventional laparoscopic adenomyomectomy.

Methods: Laparoscopic adenomyomectomy using the conventional method (group A, n = 48) and the double-flap method (group B, n = 46) to treat diffuse uterine adenomyosis, respectively. Visual analog scale (VAS), menstrual amount, serum CA125 levels, and uterine volume were comparatively analyzed in both groups.

Results: The VAS scores, menstrual amount, serum CA125 levels, and uterine volume at 12 or 24 months after surgery significantly reduced in group B than in group A (P < 0.05); these parameters were statistically decreased in both groups after surgery compared with those obtained before surgery (P < 0.001). Moreover, serum CA125 levels and uterine volume at six months of follow up were significantly lower in group B than in group A (P < 0.01). In addition, blood loss during surgery was similar in groups A and B (P > 0.05), although the operative time was significantly longer in group B than that in group A (P < 0.05).

Conclusions: Laparoscopic adenomyomectomy using the double-flap method may be an effective technique to treat uterine diffuse adenomyosis.

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Related in: MedlinePlus

Comparisons of surgical view and schematic of laparoscopic adneomyomectomy using the double-flap method and the conventional method. (A, C) Conventional method; (B, D) double-flap method.
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Fig2: Comparisons of surgical view and schematic of laparoscopic adneomyomectomy using the double-flap method and the conventional method. (A, C) Conventional method; (B, D) double-flap method.

Mentions: After adenomyotic lesions were removed (Figure 1A and E), the endometrial lining was approximated with interrupted sutures of 3–0 Vicryl (Figure 1B and F). The myometrium and serosa of the bisected uterus were sutured with 2–0 Vicryl by using the double-flap method described by Kim et al. [17], but not by using the triple-flap method proposed by Osada et al. [16]. Namely, the first flap in one side wall of the uterus (including the serosa and the myometrium) was brought into the second flap in another side of the uterine wall (including the endometrium and the myometrium) such that the other side wall of the uterus (including the endometrium and the myometrium) was covered (Figure 1C and G). Next, the second flap in another side of the uterine wall was brought to cover the first flap in one side wall of the uterus (Figure 1D and H). Before overlapping occurred, the serosal surface of the underlying flaps was stripped to ensure that only myometrial tissue flaps overlapped. During the suture procedure, dead space or hematoma between the tissues was avoided. The conventional surgical procedure was similar to that of myomectomy and completely different from the new surgical procedure (Figure 2). After the surgical procedure, we used INTERCEED (an anti adhesion membrane, Johnson company) to prevent postoperative adhesion. All excised adenomyotic tissues were confirmed by histopathology after surgery.Figure 1


Efficacy of laparoscopic adenomyomectomy using double-flap method for diffuse uterine adenomyosis.

Huang X, Huang Q, Chen S, Zhang J, Lin K, Zhang X - BMC Womens Health (2015)

Comparisons of surgical view and schematic of laparoscopic adneomyomectomy using the double-flap method and the conventional method. (A, C) Conventional method; (B, D) double-flap method.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359498&req=5

Fig2: Comparisons of surgical view and schematic of laparoscopic adneomyomectomy using the double-flap method and the conventional method. (A, C) Conventional method; (B, D) double-flap method.
Mentions: After adenomyotic lesions were removed (Figure 1A and E), the endometrial lining was approximated with interrupted sutures of 3–0 Vicryl (Figure 1B and F). The myometrium and serosa of the bisected uterus were sutured with 2–0 Vicryl by using the double-flap method described by Kim et al. [17], but not by using the triple-flap method proposed by Osada et al. [16]. Namely, the first flap in one side wall of the uterus (including the serosa and the myometrium) was brought into the second flap in another side of the uterine wall (including the endometrium and the myometrium) such that the other side wall of the uterus (including the endometrium and the myometrium) was covered (Figure 1C and G). Next, the second flap in another side of the uterine wall was brought to cover the first flap in one side wall of the uterus (Figure 1D and H). Before overlapping occurred, the serosal surface of the underlying flaps was stripped to ensure that only myometrial tissue flaps overlapped. During the suture procedure, dead space or hematoma between the tissues was avoided. The conventional surgical procedure was similar to that of myomectomy and completely different from the new surgical procedure (Figure 2). After the surgical procedure, we used INTERCEED (an anti adhesion membrane, Johnson company) to prevent postoperative adhesion. All excised adenomyotic tissues were confirmed by histopathology after surgery.Figure 1

Bottom Line: The VAS scores, menstrual amount, serum CA125 levels, and uterine volume at 12 or 24 months after surgery significantly reduced in group B than in group A (P < 0.05); these parameters were statistically decreased in both groups after surgery compared with those obtained before surgery (P < 0.001).Moreover, serum CA125 levels and uterine volume at six months of follow up were significantly lower in group B than in group A (P < 0.01).In addition, blood loss during surgery was similar in groups A and B (P > 0.05), although the operative time was significantly longer in group B than that in group A (P < 0.05).

View Article: PubMed Central - PubMed

Affiliation: The Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, 1 Xueshi Road, Hangzhou, Zhejiang, 310006, P. R. China, huangxiufeng73@163.com.

ABSTRACT

Background: Adenomyomectomy has recently been considered the priority option for the treatment of adenomyosis, however, the surgical efficacy and modes are still debated. We aimed to evaluate the efficacy of laparoscopic adenomyomectomy using a double-flap method for the treatment of uterine diffuse adenomyosis when compared with conventional laparoscopic adenomyomectomy.

Methods: Laparoscopic adenomyomectomy using the conventional method (group A, n = 48) and the double-flap method (group B, n = 46) to treat diffuse uterine adenomyosis, respectively. Visual analog scale (VAS), menstrual amount, serum CA125 levels, and uterine volume were comparatively analyzed in both groups.

Results: The VAS scores, menstrual amount, serum CA125 levels, and uterine volume at 12 or 24 months after surgery significantly reduced in group B than in group A (P < 0.05); these parameters were statistically decreased in both groups after surgery compared with those obtained before surgery (P < 0.001). Moreover, serum CA125 levels and uterine volume at six months of follow up were significantly lower in group B than in group A (P < 0.01). In addition, blood loss during surgery was similar in groups A and B (P > 0.05), although the operative time was significantly longer in group B than that in group A (P < 0.05).

Conclusions: Laparoscopic adenomyomectomy using the double-flap method may be an effective technique to treat uterine diffuse adenomyosis.

Show MeSH
Related in: MedlinePlus