Laparoscopically assisted Adenomyomectomy Using the Double/Multiple-Flap Method with Temporary Occlusion of the Bilateral Uterine Artery and Utero-Ovarian Vessels in Comparison with the Double/Multiple-Flap Only Method

Abstract

Introduction Adenomyomectomy is the most conservative surgical treatment for adenomyosis. However, the surgical efficacy of this treatment and the best approach to use are still debated. We aimed to evaluate the efficacy of laparoscopic adenomyomectomy using the double/multiple-flap method combined with temporary occlusion of the bilateral uterine artery and the utero-ovarian vessels to treat symptomatic adenomyosis.

Patients We recruited 155 patients with symptomatic adenomyosis and divided them into group A (n = 76) and group B (n = 79), with each group treated using a different surgical approach. All eligible women were informed of the potential complications, benefits, and alternatives of each approach before they were assigned into one of the two groups. In group A, we performed laparoscopic adenomyomectomy with the double/multiple-flap method while in group B, we performed a double/multiple-flap adenomyomectomy combined with temporary occlusion of the bilateral uterine artery and utero-ovarian vessels. Over a 24-month follow-up period, we evaluated operating time, intraoperative blood loss, visual analog scale (VAS) scores, anti-Mullerian hormone levels, uterine volume, and relief of menorrhagia.

Results There were no significant differences between groups A and B with respect to VAS scores, relief of menorrhagia and uterine volume at 3 months, 6 months, 12 months and 24 months after surgery (p > 0.05). Both groups showed significant improvement of these parameters after surgery compared with preoperative values (p < 0.05). Blood loss in group B was significantly lower than in group A (p < 0.001) while there was no significant difference in operating times (p > 0.05). Levels of AMH did not differ significantly between the groups throughout the follow-up period (p > 0.05).

Conclusion Laparoscopic adenomyomectomy with temporary occlusion of the bilateral uterine artery and the utero-ovarian vessels offers a feasible surgical option to treat symptomatic adenomyoma.

Zusammenfassung

Einleitung Die Adenomyomektomie stellt die konservativste aller chirurgischen Methoden zur Behandlung einer Adenomyose dar. Aber die chirurgische Effektivität dieses Verfahrens und die beste Herangehensweise werden immer noch debattiert. Ziel dieser Studie war es, die Effektivität einer laparoskopischen Adenomyomektomie unter Verwendung der Doppel-/Mehrfach-Lappen-Methode zusammen mit einer vorübergehenden Okklusion der bilateralen A. uterina und der uteroovariellen Gefäße bei der Behandlung einer symptomatischen Adenomyose zu prüfen.

Patientinnen Insgesamt wurden 155 Patientinnen mit symptomatischer Adenomyose in die Studie aufgenommen. Die Patientinnen wurden entweder in Gruppe A (n = 76) oder in Gruppe B (n = 79) eingeteilt. Die chirurgische Behandlung unterschied sich in beiden Gruppen. Alle geeigneten Patientinnen wurden über mögliche Komplikationen, Vorteile und Alternativen beider Herangehensweisen aufgeklärt, bevor sie in eine der beiden Gruppen eingeteilt wurden. Die in Gruppe A durchgeführte Operation bestand aus einer laparoskopischen Adenomyomektomie unter Einsatz der Doppel-/Mehrfach-Lappen-Methode. Dagegen wurde in Gruppe B eine Doppel-/Mehrfach-Lappen-Adenomyomektomie zusammen mit einer vorübergehenden Okklusion der bilateralen A. uterina und der uteroovariellen Gefäße durchgeführt. Die Patientinnen wurden 24 Monate lang nachbeobachtet. Ausgewertet wurden die Operationsdauer, der intraoperative Blutverlust, etwaige Änderungen der visuellen Analogskalawerte, des Anti-Müller-Hormon-Spiegels und des Gebärmuttervolumens sowie die Linderung der Menorrhagie.

Ergebnisse Es gab keine signifikanten Unterschiede zwischen Gruppe A und Gruppe B hinsichtlich der VAS-Werte, der Linderung der Menorrhagie und des Gebärmuttervolumens 3, 6, 12 und 24 Monate nach der Operation (p > 0,05). Bei beiden Gruppen gab es eine signifikante Verbesserung dieser Parameter nach der Operation, verglichen mit den präoperativen Werten (p < 0,05). Der Blutverlust in Gruppe B war signifikant niedriger als der von Gruppe A (p < 0,001). Bei der Operationsdauer gab es keine signifikanten Unterschiede zwischen beiden Gruppen (p > 0,05). Der AMH-Spiegel in der Nachbeobachtungzeit unterschied sich nicht signifikant zwischen beiden Gruppen (p > 0,05).

Schlussfolgerung Die laparoskopische Adenomyomektomie mit vorübergehender Okklusion der bilateralen A. uterina und der uteroovariellen Gefäße stellt eine praktikable chirurgische Option zur Behandlung der symptomatischen Adenomyose dar.

Key words

adenomyomectomy - bilateral uterine artery - utero-ovarian vessels - double/multiple flap - temporary occlusion

Schlüsselwörter

Adenomyomektomie - bilaterale Arteria uterina - uteroovarielle Gefäße - Doppel-/Mehrfach-Lappen - vorübergehende Okklusion

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