However many women with adenomyosis do not want to lose their uterus, and wish to be able to have children. For women who wish to become pregnant and have children, this is an awful decision to make. Yet unlike uterine myomas, or fibroids, which can easily be “shelled out” of the uterus because there is a clear line of demarcation between tumor and true uterine musculature, with adenomyosis, there is no such line of demarcation. The uterine muscle is completely infiltrated with endometriosis tissue, diffusely and throughout, and there is not even a clear demarcation of uterine lining.
But a procedure pioneered in Japan by Dr. Hisaeo Osada has solved this problem. The video on the the right shows how this operation is performed, and the scientific paper on the right describes the technique. The idea is to first prevent the massive bleeding this operation would cause by putting a temporary tourniquet around the uterus, and then to open the uterus boldly all the way down to the endometrial lining. Then the non-demarcated adenomyotic tissue is excised leaving a centimeter on the endometrial side and a centimeter on the serosal (outer) side of the uterus. Then the remaining muscle of this debulked adenomyotic uterus musculature is closed with many layers of sutures, all non-overlappying flaps, to prevent the risk of rupture.
The results are immediate and dramatic. There is almost instant relief of pelvic pain, and miserable menstrual periods, and normal periods resume with minimal pain. Furthermore, the patient is now able to get pregnant normally. She will need a C-section, but that is a small price to pay for preserving her uterus, allowing full term pregnancy, and alleviating her painful and miserable symptoms.
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