Ovarian reserve and recurrence 1 year post-operatively after using haemostatic sealant and bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy
Reproductive biomedicine online. 2021
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.
Impact of Haemostatic Sealant versus Electrocoagulation on Ovarian Reserve After Laparoscopic Ovarian Cystectomy of Ovarian Endometriomas: a Randomised Controlled Trial
BJOG : an international journal of obstetrics and gynaecology. 2019
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.