2.
Ovarian reserve and recurrence 1 year post-operatively after using haemostatic sealant and bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy
Chung JPW, Law TSM, Mak JSM, Sahota DS, Li TC
Reproductive biomedicine online. 2021
Abstract
RESEARCH QUESTION Is there a difference in the ovarian reserve 1 year post-operatively in those who used a haemostatic sealant or bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy for ovarian endometriomas? DESIGN This was an extended follow-up observational study of a previous randomized controlled trial where women aged 18 to 40 years with 3-8 cm unilateral or bilateral endometriomas were randomized to receive haemostasis by a haemostatic sealant or bipolar diathermy following ovarian cystectomy. The primary outcome was the ovarian reserve as assessed by antral follicle count (AFC) 1 year post-operatively. Secondary outcomes included the recurrence rate of ovarian endometrioma, the change in anti-Müllerian hormone (AMH) and FSH concentrations, and reproductive outcomes. RESULTS The significant increase in AFC at 3 months after initial surgery (P = 0.025) in the haemostatic sealant group compared with the diathermy group was sustained at 1 year (P = 0.024) but there was no difference in AMH or FSH concentrations between the groups throughout the follow-up period. The recurrence rate in the FloSeal group was 7.7% (n = 3/39) compared with 22.2% (n = 8/36) in the diathermy group (P = 0.060). The recurrence rate in women who had bilateral lesions was significantly higher than those with unilateral lesions (risk ratio 5.33, interquartile range 1.55-18.38). No difference in reproductive outcomes was found between the two groups. CONCLUSIONS Applying haemostatic sealant after laparoscopic cystectomy of ovarian endometriomas produces a significantly greater improvement in AFC, which was apparent at 3-month follow-up, and was sustained at 1-year follow-up without compromising the recurrence rate.
3.
Impact of Haemostatic Sealant versus Electrocoagulation on Ovarian Reserve After Laparoscopic Ovarian Cystectomy of Ovarian Endometriomas: a Randomised Controlled Trial
Chung JP, Law TSM, Chung CHS, Mak JSM, Sahota DS, Li TC
BJOG : an international journal of obstetrics and gynaecology. 2019
Abstract
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.