Impact of Haemostatic Sealant versus Electrocoagulation on Ovarian Reserve After Laparoscopic Ovarian Cystectomy of Ovarian Endometriomas: a Randomised Controlled Trial
OBJECTIVE To evaluate the effect of haemostatic sealant compared with bipolar coagulation on ovarian reserve after laparoscopic cystectomy for ovarian endometriomas. DESIGN Patient-blinded, randomised controlled trial. SETTING University-affiliated tertiary hospital. POPULATION Women aged 18 to 40 years with 3-8cm unilateral or bilateral endometriomas. METHODS 94 patients were randomised to receive haemostasis by the application of haemostatic sealant (n= 47) or
standard care (n=47). MAIN OUTCOME MEASURES Primary outcome was the effect on the antral follicular count 3 months after the operation as it captures the effect on the ovary subjected to treatment. Secondary outcomes included the change in anti-mullerian hormone, follicular-stimulating hormone and peri-operative outcomes including haemostasis, complications, pain and satisfaction scores. RESULTS A total of 94 patients aged 32.36 +/- 4.92 years underwent laparoscopic cystectomy for ovarian endometriomas. The average diameter of the endometrioma was 4.21+/- 1.38 cm. The increase in antral follicle count of the affected ovaries at 3 months in the intervention group (+2.36+/-0.37) was significantly (p=0.013) higher than that in the control group (+1.08+/-0.36). Repeated measures analysis of variance revealed significant effect with time (p=<0.001) and of interaction of group x time (p=0.029) for affected ovary antral follicle count. No significant difference was noted between the two groups with regards to follicular-stimulating hormone, anti-mullerian hormone and other the secondary outcomes. CONCLUSIONS Applying haemostatic sealant after laparoscopic cystectomy of ovarian endometriomas produced a greater increase in antral follicle count 3 months after surgery than the control group. This article is protected by copyright. All rights reserved.
