Kristyna Helenicka
It is well known that the incidence of Adenomyosis and uterine fibroids increases significantly with age. In times when the first pregnancy is postponed into the fourth or even fifth decade, there is a growing demand for fertility saving procedures for these uterine diseases. To date, the literature contains a limited number of reports describing the reproductive outcomes of patients after adenomyomectomy for severe diffuse adenomyosis, and no report has compared the reproductive, obstetrical, and surgical outcomesbetween the two different uterus-sparing surgical procedures, namely, adenomyomectomy and intramural myomectomy. Therefore,we have tried to investigate it. Two groups of women who underwent different fertility-saving procedures were compared. Thepregnancy and delivery rates were 52.0% and 43.5%, respectively, in adenomyosis group versus 96.0% and 70.8%, respectively, infibroid group, with no significant differences between the two groups, except for pregnancy rate. The perinatal outcomes of the groupswere also comparable, including the low frequency of severe peripartum complications, such as the abruption or abnormal invasion ofthe placenta. The pregnancy rate was significantly lower in the group with severe form of adenomyosis. It appears, that the severity ofthe disease and the extent of the surgical resection of the uterus may influence the likelihood of a successful gestation. The clinicaloutcomes of women after cytoreductive resection of adenomyosis seems to be comparable with the different types of fertility sparingsurgery on uterine muscularity, namely myomectomy. Despite the technical challenges resulting in longer operation times and a higheconversion rate in comparison witmyomectomy, cytoreductive resection of adenomyosis seems to be feasible option for women withsevere adenomyosis and reproductive plans.
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