Fertility Sparing Surgical Management of Adenomyosis

Abstract

<h3>Study Objective</h3> To describe the pathophysiology, diagnosis, and minimally invasive technique for fertility sparing adenomyomectomy. Postoperative outcomes including symptom control, pregnancies, and complications are also reviewed in this video. <h3>Design</h3> Video presentation. <h3>Setting</h3> University tertiary care hospital. <h3>Patients or Participants</h3> 19-year-old nulliparous patient with severe dysmenorrhea and chronic pelvic pain for 3 years who failed medical management and imaging showed a cystic adenomyoma. <h3>Interventions</h3> Adenomyosis is not uncommon in young reproductive aged women. Conservative surgical management of adenomyosis has been shown to improve painful symptoms and menorrhagia in greater than 70% of women at 1 year. The patient underwent an uncomplicated laparoscopic adenomyomectomy, endometriosis resection, diagnostic hysteroscopy, and chromopertubation. <h3>Measurements and Main Results</h3> At the 6-week postoperative follow up, the patient reported resolution of her painful symptoms. <h3>Conclusion</h3> Adenomyosis and endometriosis often coexist. Fertility sparing adenomyosis surgical management is feasible and effective when expectant or medical management is not appropriate or has failed. Patient counseling about the risks and potential uterine rupture in future pregnancies is mandatory.