Impact of the hemostatic approach after laparoscopic endometrioma excision on ovarian reserve: Systematic review and network meta-analysis of randomized controlled trials

Gaetano Riemma, Pasquale De Franciscis, Marco La Verde, Mariangela Ravo, Pietro Fumiento, Diego Domenico Fasulo, Luigi Della Corte, Carlo Ronsini, Marco Torella, Luigi Cobellis
International Journal of Gynecology & Obstetrics · 2022 · vol. 162(1) , pp. 222–232 · doi:10.1002/ijgo.14621 · PMID:36503998 · W4311124614
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This systematic review and network meta-analysis of randomized controlled trials found that suturing the ovary with either simple or barbed sutures is the most effective hemostatic approach to preserve ovarian reserve after laparoscopic endometrioma excision.

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Abstract

BACKGROUND: Laparoscopic excision of endometrioma and subsequent hemostasis have detrimental effects on ovarian reserve. OBJECTIVES: To evaluate which hemostatic approach after stripping cystectomy shows less damage on ovarian reserve. SEARCH STRATEGY: Embase, MEDLINE, Scopus, Scielo.br, LILACS, Cochrane Library at the CENTRAL Register of Controlled Trials, Clinicaltrials.gov, CINAHL, conference abstracts, and International Clinical Trials Registry Platform were searched from inception until April 2022. SELECTION CRITERIA: Randomized controlled trials of women undergoing laparoscopic endometrioma excision that compared at least two hemostatic approaches. DATA COLLECTION AND ANALYSIS: Relevant data were extracted and tabulated. Network meta-analysis based on random-effects model for mixed multiple treatment to rank hemostatic strategies using the surface under the cumulative ranking curve area (SUCRA) was performed. Quality assessment was performed using Cochrane criteria. The primary outcome was serum antimullerian hormone levels 3 months after surgery. MAIN RESULTS: Ten studies, including 748 women, were selected. Suturing the ovary with barbed suture (SUCRA, 82.80%) seem the most effective strategy to avoid antimullerian hormone reduction. Similarly, for ultrasonographic antral follicular count, barbed (SUCRA, 30.70%) and simple suture (SUCRA, 30.70%) were ranked the best choices. Ovarian suturing with simple suture demonstrated lower follicle-stimulating hormone levels (SUCRA, 88.70%). CONCLUSIONS: Suturing the ovary, with simple or barbed suture, seems the most effective approach to keep ovarian reserve higher.

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Condition tags

mesh:D004715endometrioma

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Hemostatics Hemostatics Hemostatics Hemostatics Hemostatics Hemostatics Hemostatics

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (28)

Cited by (18)

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