Surgical management of cystic adenomyosis. Why the laparoscopic approach is preferable?

Aim. To evaluate the efficacy and safety of laparoscopic surgical management of cystic adenomyosis, a rare cause of severe dysmenorrhea with poor response to medical therapy. Method. An electronic search concerning the laparoscopic treatment of cystic adenomyosis is carried out, using following key words: “adenomyotic cyst”, “cystic adenomyosis” and “laparoscopy”. We selected only the papers that described one or more cases of cystic adenomyosis treated by laparoscopic surgery. Results. Ten studies were included into the review. Mean patients age was 21.9 years. Severe dysmenorrhea was the symptom reported in all cases. The mean diameter of the cystic mass was 32 mm (ranging from 20 to 50 mm). In all selected cases, authors performed the cyst excision using laparoscopic approach. Laparoscopic cystectomy resulted in a significant reduction in symptoms. There is not recurrence of disease and severe dysmenorrhea during the follow-up period. Conclusion. In cases of cystic adenomyosis affecting patients in fertile age, conservative treatment is mandatory. Laparoscopic cystectomy should be preferred, for its minimally invasive approach and the excellent medium-term results.