Diffuse adenomyosis invades the myometrium in an unbounded manner, so, its excision has major consequences on the myometrium. While excision techniques have been reported in the scientific literature, the CEC has chosen not to apply them because of their mixed efficacy and significant risk of uterine rupture in the event of subsequent pregnancy.
Treatment of diffuse adenomyosis in case of a desire to conceive is therefore essentially medical and must be addressed on a case-by-case basis in multidisciplinary consultation and coordination with in vitro fertilization specialists.
If there is no wish for pregnancy and medical treatment has failed (through ineffectiveness or intolerance), surgical intervention in the form of laparoscopic hysterectomy is discussed. A complete extension work-up is needed in order not to underestimate the presence of other associated forms of endometriosis, which could alter the surgical strategy. The CEC has considerable experience in performing laparoscopic hysterectomies. Indeed, the procedure is now done entirely by laparoscopy, the open approach (laparotomy) having been simply abandoned. We evaluated our surgical technique and published a number of studies describing major and minor postoperative complications, which were found to be 0.44 an% and 0.5% respectively in a series of 3,290 patients. A study published in 2015 showed hospitalization to be generally short, with 90% of patients able to leave hospital the day after surgery. In some particular cases, the procedure can be performed on an outpatient basis, involving an average of 5 hours of postoperative hospitalization and low pain scores, maintained from the recovery room to the day after the procedure.
Nevertheless, hysterectomy can be difficult for patients to accept for a number of reasons. Indeed, it can have psychological repercussions and an impact on body image, which is unique to each patient. This is why, the CEC works alongside a support team to offer conditioning and counseling sessions. This yields a better understanding of the procedure on a case-by-case basis, allowing us to offer personalized support.