Our Summary

This research paper reviews various surgical treatment options for adenomyosis, a non-cancerous condition where the inner lining of the uterus breaks through the muscle wall. Traditional treatments used to involve a V-shaped cut in the uterus, but since 1990, other methods have been developed, including one that preserves fertility by creating a uterine muscle flap. The paper also discusses a procedure called laparoscopic adenomyomectomy, which is a minimally invasive surgery for treating adenomyosis, but it seems to have a higher risk of the uterus tearing compared to traditional surgery. The authors review 23 cases of uterine rupture that happened after adenomyomectomy.

FAQs

  1. What are the various surgical treatment options for adenomyosis discussed in the research?
  2. What is laparoscopic adenomyomectomy and how does it compare to traditional surgery for adenomyosis?
  3. What are the risks associated with adenomyomectomy as highlighted in the research paper?

Doctor’s Tip

One helpful tip a doctor might tell a patient about myomectomy is to discuss the risks and benefits of the different surgical techniques available. It is important to consider factors such as fertility preservation, recovery time, and potential complications when deciding on the best approach for treating adenomyosis. Additionally, patients should follow their doctor’s post-operative instructions closely to ensure a successful recovery.

Suitable For

Patients who are typically recommended myomectomy are those who have adenomyosis, a condition characterized by the presence of endometrial tissue within the muscular walls of the uterus. Adenomyosis can cause symptoms such as heavy menstrual bleeding, pelvic pain, and infertility.

Myomectomy is a surgical procedure that involves the removal of uterine fibroids, which are non-cancerous growths that can cause symptoms similar to adenomyosis. Myomectomy may be recommended for patients who have large or symptomatic fibroids that are affecting their quality of life.

In the case of adenomyosis, myomectomy may be recommended for patients who have severe symptoms that are not responsive to conservative treatments such as medication or hormonal therapy. Myomectomy may also be recommended for patients who wish to preserve their fertility, as the procedure can remove the affected tissue while leaving the uterus intact.

Overall, patients who are recommended myomectomy are those who have symptomatic adenomyosis or uterine fibroids that are impacting their quality of life and who wish to preserve their fertility. It is important for patients to discuss the risks and benefits of myomectomy with their healthcare provider to determine if it is the right treatment option for their individual situation.

Timeline

Before a myomectomy:

  1. Symptoms of adenomyosis may include heavy menstrual bleeding, severe menstrual cramps, and pelvic pain.
  2. A patient may undergo various diagnostic tests, such as ultrasound, MRI, or hysteroscopy, to confirm the diagnosis of adenomyosis.
  3. The patient may explore different treatment options, including medication, hormonal therapy, or other non-surgical interventions.
  4. If conservative treatments are not effective, the patient and their healthcare provider may decide that a myomectomy is necessary to remove the adenomyosis lesions.

After a myomectomy:

  1. The patient undergoes the myomectomy surgery, either through traditional open surgery or minimally invasive techniques like laparoscopic or robotic surgery.
  2. Recovery time varies depending on the type of surgery performed, but patients generally experience pain and discomfort for a few days to weeks after the procedure.
  3. The patient will have follow-up appointments with their healthcare provider to monitor their recovery and address any concerns or complications.
  4. Depending on the patient’s specific situation, they may be able to resume normal activities within a few weeks to months after the surgery.
  5. The patient may experience improvements in their symptoms, such as reduced menstrual bleeding and pain, as the adenomyosis lesions are removed.
  6. For patients looking to preserve fertility, a myomectomy may allow them to still have the option of getting pregnant in the future.
  7. Long-term outcomes of a myomectomy may vary, and some patients may require additional treatments or procedures in the future to manage adenomyosis.

What to Ask Your Doctor

  1. What are the risks and benefits of undergoing a myomectomy for treating adenomyosis?
  2. What is the success rate of myomectomy in treating adenomyosis?
  3. Are there any alternative treatment options for adenomyosis besides myomectomy?
  4. How long is the recovery time after undergoing a myomectomy?
  5. Will my fertility be affected by undergoing a myomectomy?
  6. What are the potential complications of myomectomy surgery?
  7. How many cases of uterine rupture have occurred after adenomyomectomy in your experience?
  8. What steps will be taken during the surgery to minimize the risk of uterine rupture?
  9. How will my post-operative care plan be managed to prevent complications?
  10. Are there any long-term effects or risks associated with undergoing a myomectomy for adenomyosis?

Reference

Authors: Osada H. Journal: Fertil Steril. 2018 Mar;109(3):406-417. doi: 10.1016/j.fertnstert.2018.01.032. PMID: 29566853