Combined modified two-stage Osada–Strassmann surgery in a patient with severe concurrent pathology (a complete bicornuate uterus, diffusive adenomyosis, and deep infiltrating endometriosis)

Tskhay V.B., Mikailly T.K., Andreeva A.A.

1) Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, Krasnoyarsk, Russia; 2) Federal Siberian Research and Clinical Center, Federal Biomedical Agency, Krasnoyarsk, Russia; 3) Territorial Regional Center for Maternal and Child Care, Krasnoyarsk, Russia
Background: Young patients with a concurrence of various severe gynecological diseases are now increasingly being observed in the practice of an obstetrician/gynecologist. The treatment of these women, primarily surgical treatment, presents a significant challenge due to the need to preserve reproductive function.
Case report: The paper presents the authors’ clinical observation of successful two-stage surgery in a young patient with complex concurrent pathology: grade 3 diffuse adenomyosis; infiltrating endometriosis of the uterovesical fold, retrocervical endometriosis, complete bicornuate uterus (uterus bicornis bicollis), and primary infertility. During the laparoscopic stage, endometriosis focus removal, adhesiolysis, and bilateral tubectomy were done; during the laparotomic stage, adenomyomectomy for severe diffuse adenomyosis using the method of H. Osada in each of the uterus, subsequent metroplasty, and creation of a single uterus by the modified Strassmann method, by taking into account the individual characteristics of a patient and the presence of complex concurrent pathology.
Conclusion: Severe concurrent gynecological pathology required surgical treatment consisting of several stages. The performed operation was not just a combination of two techniques, but also needed a particular modification in terms of the individual characteristics of a patient and the presence of complex concurrent pathology. The surgical treatment restored the normal anatomy of the internal genital organs, which leaves the patient with a chance to realize her reproductive function.


diffuse adenomyosis
external genital endometriosis
complete bicornuate uterus
surgical treatment


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Received 11.04.2022

Accepted 06.06.2022

About the Authors

Vitaly B. Tskhay, Dr. Med. Sci., Professor, Head of the Department of Perinatology, Obstetrics and Gynecology, Krasnoyarsk State Medical University
named after Prof. V.F. Voino-Yasenetsky, Ministry of Health of Russia; Scientific Supervisor of Obstetrics and Gynecology, Federal Siberian Scientific and Clinical Center
of the FMBA of Russia; +7(923)287-21-34,, 660022, Russia, Krasnoyarsk, Partizan Zheleznyak str., 1.
Mikailly Gulnar Telman kyzy, Assistant of the Department of Perinatology, Obstetrics and Gynecology, Krasnoyarsk State Medical University
named after Prof. V.F. Voino-Yasenetsky, Ministry of Health of Russia; obstetrician-gynecologist, Krasnoyarsk Regional Clinical Center for Maternal and Child Health, +7(996)429-33-03, , 600074, Russia, Krasnoyarsk, Ac. Kirensky str., 2a.
Alla A. Andreeva, Head of the Gynecological Department, Krasnoyarsk Regional Clinical Center for Maternal and Child Health,
+7(904)890-68-08, , 600074, Russia, Krasnoyarsk, Ac. Kirensky str., 2a.

Authors’ contributions: Tskhay V.B. – the concept and design of the study, surgery of the patient, writing the manuscript, editing; Mikailly T.K. – data collection and processing of the material, patient management, article design; Andreeva A.A. – collection of clinical material, surgery of the patient.
Conflicts of interest: The authors declare that there are no possible conflicts of interest.
Funding: The investigation has not been sponsored.
Patient Consent for Publication: The patient provided informed consent for the publication of her data and associated images.
For citation: Tskhay V.B., Mikailly T.K., Andreeva A.A. Combined modified two-stage Osada–Strassmann surgery in a patient with severe concurrent pathology (a complete bicornuate uterus, diffusive adenomyosis, and deep infiltrating endometriosis).
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 8: 163-169 (in Russian)

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