{"paper_id":"248c9a6c-4835-4c5e-ba85-2e00e2208c0b","body_text":"Abstract\nIntroduction\nThe use of the hemostatic sutures minimizes the damage related to the use of cautery in the ovarian bed after cystectomy. The main concern for the wide use of this method is the concerns about the safety of the sutures as the hemostasis seems to be incomplete when compared to cauterization.\nAim\nTo study the safety of hemostatic sutures for achieving hemostasis of the ovarian bed after ovarian cystectomy of endometrioma.\nDesign\nProspective cohort controlled study.\nSetting\nShatby maternity University hospital.\nMethods\nEighty-four women with endometrioma were included in the study. Patients were randomized to laparoscopic ovarian cystectomy with use of electrocautery (bipolar or unipolar) or use of sutures for control of bleeding from the ovarian bed. All cases underwent laparoscopy for removal of ovarian endometriomas by stripping. Hemostasis of the bleeding from the ovarian bed was controlled by either electrocautery (bipolar or monopolar) or hemostatic sutures. Effect of the use of both methods was studied including hemoglobin level, hematocrit level, duration of surgery, number of sutures needed, duration of hospital stay, need for blood transfusion and postoperative complications including ovarian hematomas. There was a routine use of intraperitoneal drain in all suture cases.\nResults\nIt was found that using hemostatic suture was effective in controlling the bleeding from the ovarian bed. The hemoglobin and the hematocrit were comparable in both groups. Complications for both techniques were documented and treated.\nConclusion\nIt could be concluded that hemostatic sutures are safe procedure and tolerable for the patient although more cases with complication in the suture group which was not statistically significant and there was longer hospital stay. This technique has the advantage of minimizing the damage of cystectomy to stripping only by avoiding cauterization of healthy ovarian tissues.\nSimilar content being viewed by others\nReferences\nFedele L, Bianchi S, Zanconato G, Bergamini V, Berlanda N. Bipolar electrocoagulation versus suture of solitary ovary after laparoscopic excision of ovarian endometriomas. J Am Assoc Gynecol Laparosc. 2004;11:344–7.\nSomigliana E, Ragni G, Benedetti F, Borroni R, Vegetti W, Crosignani PG. Does laparoscopic excision of endometriotic ovarian cysts significantly affect ovarian reserve? Insights from IVF cycles. Hum Reprod. 2003;18:2450–3.\nNargund G, Cheng WC, Parsons J. The impact of ovarian cystectomy on ovarian response to stimulation during in vitro fertilization cycles. Hum Reprod. 1996;11:81–3.\nLoh FH, Tan AT, Kumar J, Kumar J, Ng SC. Ovarian response after laparoscopic ovarian cystectomy for endometriotic cysts in 132 monitored cycles. Fertil Steril. 1999;72:316–21.\nHo HY, Lee RK, Hwu YM, Lin MH, Su JT, Tsai YC. Poor response of ovaries with endometrioma previously treated with cystectomy to controlled ovarian hyperstimulation. J Assist Reprod Genet. 2002;19:507–11.\nCandiani M, Barbieri M, Bottani B, Bertulessi C, Vignali M, Agnoli B, et al. Ovarian recovery after laparoscopic enucleation of ovarian cysts: Insights from echographic short-term postsurgical follow-up. J Minim Invasive Gynecol. 2005;12:409–14.\nMuzii L, Bianchi A, Croce’ C, Manci N, Benedetti Panici P. Laparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure? Fertil Steril. 2002;77:609–14.\nMuzii L, Bellati F, Bianchi A, Palaia I, Manci N, Zullo MA, et al. Laparoscopic stripping of endometriomas: a randomized trial on different surgical techniques. Part II: pathological results. Hum Reprod. 2005;20:1987–92.\nLi C-Z, Liu B, Wen ZQ, Sun Q. The impact of electrocoagulation on ovarian reserve after laparoscopic excision of ovarian cysts: a prospective clinical study of 191 patients. Fertil Steril. 2009;92(4):1428–35.\nMais V, Ajossa S, Piras B, Marongiu D, Guerriero S, Melif GB. Treatment of nonendometriotic benign adnexal cyst: a randomized comparison of laparoscopy and laparotomy. Obstet Gynecol. 1995;86:770–4.\nLuciano AA, Lowney J, Jacobs SL. Endoscopic treatment of endometriosis-associated infertility. Therapeutic, economic and social benefits. J Reprod Med. 1992;37:573–6.\nYuen PM, Yu KM, Yip SK, Lau WC, Rogers MS, Chang A. A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol. 1997;177:109–14.\nLundorff P, Hahlin M, Kallfelt B, Thorburn J, Lindblom B. Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy. Fertil Steril. 1991;55:911–5.\nHart R, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev. 2008;16:004992.\nRiedel HH, Staner U, Mecke H. Results of electron microscopy studies of the uterine horn of the New Zealand rabbit following use of 4 different coagulation methods. Zentralbl Gynakol. 1987;109:1350–67.\nTakashima A, Takeshita N, Otaka K, Kinoshita T. Effects of bipolar electrocoagulation versus suture after laparoscopic excision of ovarian endometrioma on ovarian reserve and in vitro fertilization outcome. Fertil Steril. 2011;96(3):S139.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nConflict of interest\nAll authors have nothing to declare.\nFunding\nThis study was not funded.\nEthical Approval\nAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\nInformed Consent\nInformed consent was obtained from the patient included in the study.\nRights and permissions\nAbout this article\nCite this article\nMahmoud, T.H., El-Agwany, A.S. Safety of Hemostatic Sutures for Hemostasis of the Ovarian Bed After Endometriotic Ovarian Cystectomy. Indian J Gynecol Oncolog 14, 36 (2016). https://doi.org/10.1007/s40944-016-0065-1\nReceived:\nAccepted:\nPublished:\nDOI: https://doi.org/10.1007/s40944-016-0065-1","source_license":"CC0","license_restricted":false}