Laparoscopic adenomyomectomy combined with levonorgestrel-releasing intrauterine system is effective for long-term management of adenomyosis

• Published in: BMC women's health Vol. 24; no. 1; p. 28
• Main Authors: Jiang, Jilan, Pan, Yilian, Yu, Jin, Zhang, Ye, Yang, Yeping, Xu, Hong, Sun, Feng
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.01.2024; BioMed Central; BMC
• Subjects: Adenomyosis; Adenomyosis - complications; Adenomyosis - surgery; Analysis; Blood transfusions; Care and treatment; Contraceptive drug implants; Drug therapy; Endometriosis; Endometriosis - complications; Endometriosis - drug therapy; Endometriosis - surgery; Female; Hemoglobin; Hospitals; Humans; Intrauterine Devices; Laparoscopic adenomyomectomy; Laparoscopic surgery; Laparoscopy; Levonorgestrel; Levonorgestrel - therapeutic use; Levonorgestrel-releasing intrauterine system; Medical records; Menstruation; Patients; Recurrence; Retrospective Studies; Risk factors; Surgery; Ultrasonic imaging; Uterus; United States > US; China; Recurrence; Laparoscopic adenomyomectomy; Levonorgestrel-releasing intrauterine system; Adenomyosis
• ISSN: 1472-6874; 1472-6874
• DOI: 10.1186/s12905-023-02795-1

Laparoscopic adenomyomectomy combined with intraoperative placement of levonorgestrel-releasing intrauterine device (LNG-IUS) is a novel conservative surgical procedure for adenomyosis. Our study aimed to compare the efficacy of surgery with or without intraoperative placement of LNG-IUS treatment in adenomyosis. We retrospectively reviewed the medical records of adenomyosis patients who received laparoscopic adenomyomectomy from January 2014 to April 2020, finally including 70 patients undergoing surgery-LNG-IUS as group A and 69 patients undegoing surgery only as group B. Risk factors for three-year relapse were analyzed using Cox's multivariate proportional hazard analysis. Visual analog scale and Mansfield-Voda-Jorgensen Menstrual Bleeding Scale scores of group A at 3, 6, 12, 24, and 36 months were significantly lower than those of group B at the corresponding points (P < .001 for both scales). Individuals in both groups showed statistically significant symptom relief. The recurrence rate in group A was significantly lower than that in group B at 36 months after the surgery (2.94% vs. 32.84%, P < .001). A cox proportional hazard model showed that relapse was significantly associated with coexisting ovarian endometriosis (adjusted hazard ratio [aHR], 2.94; 95% confidence interval [CI], 1.33-7.02, P = .015). Patients who received surgery-LNG-IUS had a lower risk of recurrence than those with surgery-alone (aHR, 0.07; 95% CI, 0.016-0.31, P < .001). Conservative surgery with intraoperative placement of LNG-IUS is effective and well-accepted for long-term therapy with a lower recurrence rate for adenomyosis. Coexistent ovarian endometriosis is a major factor for adenomyosis relapse.