Ovarian reserve and recurrence 1 year post-operatively after using haemostatic sealant and bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy

Jacqueline Pui Wah Chung, Tracy Sze Man Law, Law TSM, Jennifer Sze Man Mak, Daljit Singh Sahota, Sahota DS, Tin Chiu Li, Li TC
Reproductive BioMedicine Online · 2021 · vol. 43(2) , pp. 310–318 · doi:10.1016/j.rbmo.2021.05.003 · PMID:34193356 · W3162970446
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This study evaluated ovarian reserve and recurrence rates one year after laparoscopic ovarian cystectomy, comparing the use of hemostatic sealant versus bipolar diathermy for controlling bleeding.

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Abstract

Research questionIs 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?DesignThis 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.ResultsThe 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.ConclusionsApplying 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.

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Condition tags

endometriosis

MeSH descriptors

Diathermy Gelatin Sponge, Absorbable Neoplasm Recurrence, Local Neoplasm Recurrence, Local Neoplasm Recurrence, Local Ovarian Cysts Ovarian Reserve Ovarian Reserve Adolescent Adult Diathermy Endometriosis Endometriosis Endometriosis Endometriosis Female Follow-Up Studies Gelatin Sponge, Absorbable Hemostatics Hemostatics

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