Combined modified two-stage Osada–Strassmann surgery in a patient with severe concurrent pathology (a complete bicornuate uterus, diffusive adenomyosis, and deep infiltrating endometriosis)
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.Tskhay V.B., Mikailly T.K., Andreeva A.A.
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.
Keywords
diffuse adenomyosis
external genital endometriosis
complete bicornuate uterus
surgical treatment
References
- Адамян Л.В., Салимова Д.Ф., Кондратович Л.М. Патогенетические аспекты эндометриоз-ассоциированного бесплодия. Проблемы репродукции. 2015; 21(6): 90-6. [Adamyan L.V., Salimova D.F., Kondratovich L.M. Pathogenetic aspects of endometriosis-associated infertility. Russian Journal of Human Reproduction. 2015; 21(6): 90 6. (in Russian)].https://doi.org/10.17116/repro201521682-88
- Tanbo T., Fedorcsak P. Endometriosis-associated infertility: aspects of pathophysiological mechanisms and treatment options. Acta Obstet. Gynecol. Scand. 2017; 96(6): 659-67. https://dx.doi.org/10.1111/aogs.13082.
- Filip L., Duică F., Prădatu A., Crețoiu D., Suciu N., Crețoiu S.M. et al. Endometriosis associated infertility: a critical review and analysis on etiopathogenesis and therapeutic approaches. Medicina (Kaunas). 2020; 56(9): 460. https://dx.doi.org/10.3390/medicina56090460.
- Чернуха Г.Е., Марченко Л.А., Гусев Д.В. Поиск оптимальных решений и пересмотр тактики ведения пациенток с эндометриозом. Акушерство и гинекология. 2020; 8: 12-20. [Chernukha G.E., Marchenko L.A., Gusev D.V. Searching for optimal decisions and revising management tactics for patients with endometriosis. Obstetrics and Gynecology. 2020; 8: 12-20. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.8.12-20.
- Радзинский В.Е., Оразов М.Р., Орехов Р.Е. Индивидуализированный подход в терапии боли, ассоциированной с эндометриозом. Акушерство и гинекология. 2021; 10: 31-7. [Radzinsky V.E., Orazov M.R., Orekhov R.E. Treatment of endometriosis-associated pain: an individualized approach. Obstetrics and Gynecology. 2021; 10: 31-7. (in Russian)]. https://dx.doi.org/10.18565/aig.2021.10.31-37.
- Broi M.G.D., Ferriani R.A., Navarro P.A. Ethiopathogenic mechanisms of endometriosis-related infertility. JBRA Assist. Reprod. 2019; 23(3): 273-80. https://dx.doi.org/10.5935/1518-0557.20190029.
- Chapron C., Tosti C., Marcellin L., Bourdon M., Lafay-Pillet M.C., Millischer A.E. et al. Relationship between the magnetic resonance imaging appearance of adenomyosis and endometriosis phenotypes. Hum. Reprod. 2017; 32(7):1393-401. https://dx.doi.org/10.1093/humrep/dex088.
- Leyendecker G., Bilgicyildirim A., Inacker M., Stalf T., Huppert P., Mall G. et al. Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study. Arch. Gynecol. Obstet. 2015; 291(4): 917-32. https://dx.doi.org/10.1007/s00404-014-3437-8.
- Leyendecker G., Wildt L. A new concept of endometriosis and adenomyosis: tissue injury and repair (TIAR). Horm. Mol. Biol. Clin. Investig. 2011; 5(2): 125-42. https://dx.doi.org/10.1515/HMBCI.2011.002.
- Alborzi S., Askary E., Khorami F., Poordast T., Alkhalidi B.A.H., Hamedi M. et al. A detailed study in adenomyosis and endometriosis: evaluation of the rate of coexistence between uterine adenomyosis and DIE according to imaging and histopathology findings. Reprod. Sci. 2021; 28(8): 2387-97.https://dx.doi.org/10.1007/s43032-021-00527-0.
- Donnez J., Dolmans M.M., Fellah L. What if deep endometriotic nodules and uterine adenomyosis were actually two forms of the same disease? Fertil. Steril. 2019; 111(3): 454-6. https://dx.doi.org/10.1016/j.fertnstert.2018.12.018.
- Guo S.W. The pathogenesis of adenomyosis vis-à-vis endometriosis. J. Clin. Med. 2020; 9(2): 485. https://dx.doi.org/10.3390/jcm9020485. 10.3390/jcm9020485.
- Marcellin L., Santulli P., Bortolato S., Morin C., Millischer A.E., Borghese B., Chapron C. Anterior focal adenomyosis and bladder deep infiltrating endometriosis: is there a link? J. Minim. Invasive Gynecol. 2018; 25(5):896-901. https://dx.doi.org/10.1016/j.jmig.2018.02.002.
- Piriyev E., Römer T. Coincidence of uterine malformations and endometriosis: a clinically relevant problem? Arch. Gynecol. Obstet. 2020; 302(5): 1237-41. https://dx.doi.org/10.1007/s00404-020-05750-9.
- Freytag D., Mettler L., Maass N., Günther V., Alkatout I. Uterine anomalies and endometriosis. Minerva Med. 2020; 111(1): 33-49. https://dx.doi.org/ 10.23736/S0026-4806.19.06341-9.
- Wang S., Lang J.H., Zhu L. Clinical study of 67 cases of endometriosis coexisting with genital tract anomalies. Zhonghua Fu Chan Ke Za Zhi. 2013; 48(9): 663-6. (In Chinese).
- Hur J.Y., Shin J.H., Lee J.K., Oh M.J., Saw H.S., Park Y.K., Lee K.W. Septate uterus with double cervices, unilaterally obstructed vaginal septum, and ipsilateral renal agenesis: a rare combination of mullerian andwolffian anomalies complicated by severe endometriosis in an adolescent. J. Minim. Invasive Gynecol. 2007; 14(1): 128-31. https://dx.doi.org/10.1016/j.jmig.2006.08.010.
- LaMonica R., Pinto J., Luciano D., Lyapis A., Luciano A. Incidence of septate uterus in reproductive-aged women with and without endometriosis. J. Minim. Invasive Gynecol. 2016; 23(4): 610-3. https://dx.doi.org/10.1016/j.jmig.2016.02.010.
- Osada H., Silber S., Kakinuma T., Nagaishi M., Kato K., Kato O. Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod. Biomed. Online. 2011; 22(1): 94-9.https://dx.doi.org/10.1016/j.rbmo.2010.09.014.
- Maruyama S., Imanaka S., Nagayasu M., Kimura M., Kobayashi H. Relationship between adenomyosis and endometriosis; Different phenotypes of a single disease? Eur. J. Obstet. Gynecol. Reprod. Biol. 2020; 253: 191-7.https://dx.doi.org/10.1016/j.ejogrb.2020.08.019.
- Harada T., Taniguchi F., Amano H., Kurozawa Y., Ideno Y., Hayashi K., Harada T.; Japan Environment and Children’s Study Group. Adverse obstetrical outcomes for women with endometriosis and adenomyosis: a large cohort of the Japan Environment and Children's Study. PLoS One. 2019; 14(8): e0220256. https://dx.doi.org/10.1371/journal.pone.0220256.
- Аксененко А.А., Гус А.И., Мишиева Н.Г. Аденомиоз и бесплодие. Акушерство и гинекология. 2021; 4: 41-7. [Aksenenko A.A., Gus A.I., Mishieva N.G. Adenomyosis and infertility. Obstetrics and Gynecology. 2021; 4: 41-7.(in Russian)]. https://dx.doi.org/10.18565/aig.2021.4.41-47.
- Цхай В.Б., Khudyakov A., Terjyng A., Полстяной А.М., von Westernhagen M., Avazashvili Z., Fullers U., Friedrich M., Полстяная О.Ю. Оперативное лечение глубокого инфильтративного эндометриоза с поражением кишечника. Клинический случай. Сибирское медицинское обозрение. 2021; 3: 101-6. [Tskhay V.B., Khudyakov A., Terjyng A., Polstianoy A.M., Westernhagen M., Avazashvili Z., Fullers U., Friedrich M., Polstianaya O.Yu. Surgical treatment of deep infiltrative endometriosis with intestinal damage. A clinical case. Siberian Medical Review. 2021; 3: 101-6. (in Russian)].https://dx.doi.org/10.20333/25000136-2021-3-101-106.
- Рухляда Н.Н., Крылов К.Ю., Бирюкова Е.И. Возможности органосохраняющих операций при аденомиозе в аспекте сохранения репродуктивной функции. Акушерство и гинекология. 2018; 7: 120-4. [Rukhlyada N.N., Krylov K.Yu., Biryukova E.I. Possibilities of organ-sparing surgery for adenomyosis in the context of reproductive function preservation. Odstetrics and Gynecology. 2018; 7:120-4. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.7.120-124.
- Цхай В.Б., Микаиллы Г.Т., Костарева О.В., Каплунов В.А., Руф Р.Р. Беременность и роды после радикальной аденомиомэктомии и метропластики по методу Хисао Осада у женщин с диффузным аденомиозом, ассоциированным с бесплодием. Российский вестник акушера-гинеколога. 2019; 19(2): 63-7. [Tskhaĭ V.B., Mikailly G.T., Kostareva O.V., Kaplunov V.A., Ruf R.R. Pregnancy and labor after radical adenomyomectomy and metroplasty using the procedure developedby Hisao Osada in women with diffuse adenomyosis associated with infertility. Russian Bulletin of Obstetrician-Gynecologist. 2019; 19(2): 63-7. (in Russian)]. https://doi.org/10.17116/rosakush20191902163.
- Jun-Min X., Kun-Peng Z., Yin-Kai Z., Ya-Qin Z., Xiao-Fan F., Xiao-Yu Z. et al. A new surgical method of U-shaped myometrial excavation and modified suture approach with uterus preservation for diffuse adenomyosis. Biomed. Res. Int. 2018; 2018: 1657237. https://dx.doi.org/10.1155/2018/1657237.
- Huang X., Huang Q., Chen S., Zhang J., Lin K., Zhang X. Efficacy of laparoscopic adenomyomectomy using double-flap method for diffuse uterine adenomyosis. BMC Womens Health. 2015; 15: 24. https://dx.doi.org/10.1186/s12905-015-0182-5.
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 Universitynamed 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, tchai@yandex.ru, 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, miktsgm@mail.ru , 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, alla.andreeva.2012@bk.ru , 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)
https://dx.doi.org/10.18565/aig.2022.8.163-169
Similar Articles
