In Search for an Effective Conservative Surgery for Diffuse Adenomyosis in a Resource-Constrained Setting: Outcome of Open Double-Flap Adenomyomectomy in Infertile Women

Abstract

OBJECTIVES: Adenomyosis is a common cause of pelvic pain, menorrhagia, and infertility in women of reproductive age. There remains a need for an effective fertility-sparing surgical option for managing diffuse adenomyosis. This study evaluated the clinical and reproductive outcomes of open double-flap adenomyomectomy in infertile women in a resource-poor setting. STUDY DESIGN: This prospective observational cohort study was conducted between July 2024 and December 2025. Twenty-four infertile women with diffuse adenomyosis underwent open double-flap adenomyomectomy and were followed up for 12 months. Clinical and postoperative outcomes were analyzed. The severity of menorrhagia and dysmenorrhea was assessed using a Visual Analog scale (VAS) serially over 12 months postoperatively. Reproductive outcomes were also evaluated in women who subsequently had assisted reproductive treatment. RESULTS: The mean age of the women studied was 40.9±5.6 years, while the average duration of infertility was 7.4±3.4 years. The mean uterine size was 17.3±2.5 weeks. Mean blood loss was 285±222.9 ml, and 29.2% of the women required blood transfusion. The average duration of surgery was 135.9±75.6 minutes. One woman (4.2%) developed postoperative pelvic abscess. Appreciable improvement in menorrhagia and dysmenorrhea was observed, as demonstrated by declining VAS scores during follow-up. Nine women underwent in vitro fertilization, of whom 3 achieved pregnancy. CONCLUSION: Double-flap open adenomyomectomy may result in symptom relief and appreciable fertility outcomes in women with diffuse adenomyosis. The procedure appears safe, with low complication