Gauze packing may be a better hemostatic method to protect ovarian reserve during laparoscopic endometrioma cystectomy than conventional hemostatic methods

Purpose To compare the ovarian reserve of different hemostatic methods after laparoscopic endometrioma stripping (LES) and explore which factors may affect ovarian reserve.

Patients who underwent LES from January 2019 to December 2021 were retrospectively included. Anti-Müllerian hormone (AMH) levels were measured before, and 3 months after surgery to determine changes of serum AMH in each patient. A multivariate linear regression analysis was performed to identify significant factors that were associated with the rate of decline of serum AMH levels at month 3 after surgery.

A total of 67 patients who underwent LES were included. Of these patients, 20 with gauze packing, 24 with bipolar dessication (BD), and 23 with suture to achieve hemostasis. The 3 groups were similar in terms of demographics, cyst diameter, and basal AMH levels, except basal hemoglobin levels. At 3 months after surgery, the decline rate of AMH levels was significantly greater in the suture and BD group compared with the gauze packing group [48.2% (interquartile range, IQR, 28.1–67.1) and 31.1% (IQR,14.6–49.1) vs. 15.1% (IQR,1.1–24.5), P = 0.001]. On multivariate regression models, significant predictors of the decline rate of serum AMH levels at 3 months after surgery were hemostatic methods (p < 0.001), basal AMH levels (p = 0.033), and lesion bilaterality (p = 0.017).

Compared to BD or suturing hemostasis, gauze packing hemostasis led to less damage on ovarian reserve at 3 months after LES. Besides, hemostatic methods, bilateral endometriomas and basal ovarian reserve were independently correlated with the impairment of ovarian reserve after surgery. Similar content being viewed by others Data availability The data that support the findings of current study are available on reasonable request from the first/corresponding author.

Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, Kluivers KB (2015) Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev: CD003677. https://doi.org/10.1002/14651858.CD003677.pub5 Mansouri G, Safinataj M, Shahesmaeili A, Allahqoli L, Salehiniya H, Alkatout I (2022) Effect of laparoscopic cystectomy on ovarian reserve in patients with ovarian cyst. Front Endocrinol (Lausanne). 13:964229. https://doi.org/10.3389/fendo.2022.964229 Anh ND, Ha NTT, Tri NM, Huynh DK, Dat DT, Thuong PTH, Toan NK, Duc TA, Hinh ND, Tong HV (2022) Long-term follow-up of anti-Mullerian hormone levels after laparoscopic endometrioma cystectomy. Int J Med Sci. 19:651–658. https://doi.org/10.7150/ijms.69830 Asgari Z, Rouholamin S, Hosseini R, Sepidarkish M, Hafizi L, Javaheri A (2016) Comparing ovarian reserve after laparoscopic excision of endometriotic cysts and hemostasis achieved either by bipolar coagulation or suturing: a randomized clinical trial. Arch Gynecol Obstet. 293:1015–1022. https://doi.org/10.1007/s00404-015-3918-4 Chung J, Law T, Chung C, Mak J, Sahota DS, Li TC (2019) Impact of haemostatic sealant versus electrocoagulation on ovarian reserve after laparoscopic ovarian cystectomy of ovarian endometriomas: a randomised controlled trial. BJOG. 126:1267–1275. https://doi.org/10.1111/1471-0528.15807 Araujo R, Maia SB, Baracat CMF, Fernandes C, Ribeiro H, Ribeiro P (2022) Ovarian function following use of various hemostatic techniques during treatment for unilateral endometrioma: A randomized controlled trial. Int J Gynaecol Obstet. 157:549–556. https://doi.org/10.1002/ijgo.13912 Chung JPW, Law TSM, Mak JSM, Sahota DS, Li TC (2021) Ovarian reserve and recurrence 1 year post-operatively after using haemostatic sealant and bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy. Reprod Biomed Online. 43:310–318. https://doi.org/10.1016/j.rbmo.2021.05.003 Thomas PJ, Tawfic SN (2009) Eosinophil-rich inflammatory response to FloSeal hemostatic matrix presenting as postoperative pelvic pain. Am J Obstet Gynecol. https://doi.org/10.1016/j.ajog.2008.10.052 Alammari R, Lightfoot M, Hur HC (2017) Impact of zature. J Minim Invasive Gynecol. 24:247–257 Ata B, Turkgeldi E, Seyhan A, Urman B (2015) Effect of hemostatic method on ovarian reserve following laparoscopic endometrioma excision; comparison of suture, hemostatic sealant, and bipolar dessication. A systematic review and meta-analysis. J Minim Invasive Gynecol. 22:363–372 Li CZ, Liu B, Wen ZQ, Sun Q (2009) The impact of electrocoagulation on ovarian reserve after laparoscopic excision of ovarian cysts: a prospective clinical study of 191 patients. Fertil Steril 92:1428–1435 Song T, Kim WY, Lee KW, Kim KH (2015) Effect on ovarian reserve of hemostasis by bipolar coagulation versus suture during laparoendoscopic single-site cystectomy for ovarian endometriomas. J Minim Invas Gynecol 22:415–420 Ferrero S, Venturini PL, Gillott DJ, Remorgida V, Leone Roberti Maggiore U (2012) Hemostasis by bipolar coagulation versus suture after surgical stripping of bilateral ovarian endometriomas: a randomized controlled trial. J Minim Invasive Gynecol. 19:722–730 Peters A, Rindos NB, Lee T (2017) Hemostasis during ovarian cystectomy: systematic review of the impact of suturing versus surgical energy on ovarian function. J Minim Invasive Gynecol. 24:235–246 Zhang CH, Wu L, Li PQ (2016) Clinical study of the impact on ovarian reserve by different hemostasis methods in laparoscopic cystectomy for ovarian endometrioma. Taiwan J Obstet Gynecol. 55:507–511 Deckers P, Ribeiro SC, Simoes RDS, Miyahara C, Baracat EC (2018) Systematic review and meta-analysis of the effect of bipolar electrocoagulation during laparoscopic ovarian endometrioma stripping on ovarian reserve. Int J Gynaecol Obstet. 140:11–17 Ferrero S, Scala C, Racca A, Calanni L, Remorgida V, Venturini PL, Leone Roberti Maggiore U (2015) Second surgery for recurrent unilateral endometriomas and impact on ovarian reserve: a case-control study. Fertil Steril. 103:1236–1243 Takashima A, Takeshita N, Otaka K, Kinoshita T (2013) Effects of bipolar electrocoagulation versus suture after laparoscopic excision of ovarian endometrioma on the ovarian reserve and outcome of in vitro fertilization. J Obstet Gynaecol Res. 39:1246–1252 Kovacevic VM, Andelic LM, Mitrovic Jovanovic A (2018) Changes in serum antimullerian hormone levels in patients 6 and 12 months after endometrioma stripping surgery. Fertil Steril. 110:1173–1180 Turkcuoglu I, Melekoglu R (2018) The long-term effects of endometrioma surgery on ovarian reserve: a prospective case-control study. Gynecol Endocrinol. 34:612–615 Wang Y, Ruan X, Lu D, Sheng J, Mueck AO (2019) Effect of laparoscopic endometrioma cystectomy on anti-Mullerian hormone (AMH) levels. Gynecol Endocrinol. 35:494–497 Mehdizadeh Kashi A, Chaichian S, Ariana S, Fazaeli M, Moradi Y, Rashidi M, Najmi Z (2017) The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometrioma. Int J Gynaecol Obstet. 136:200–204 Ozaki R, Kumakiri J, Tinelli A, Grimbizis GF, Kitade M, Takeda S (2016) Evaluation of factors predicting diminished ovarian reserve before and after laparoscopic cystectomy for ovarian endometriomas: a prospective cohort study. J Ovarian Res. 9:37 Younis JS, Shapso N, Fleming R, Ben-Shlomo I, Izhaki I (2019) Impact of unilateral versus bilateral ovarian endometriotic cystectomy on ovarian reserve: a systematic review and meta-analysis. Hum Reprod Update. 25:375–391 Hirokawa W, Iwase A, Goto M, Takikawa S, Nagatomo Y, Nakahara T, Bayasula B, Nakamura T, Manabe S, Kikkawa F (2011) The post-operative decline in serum anti-Mullerian hormone correlates with the bilaterality and severity of endometriosis. Hum Reprod. 26:904–910 Kwon SK, Kim SH, Yun SC, Kim DY, Chae HD, Kim CH, Kang BM (2014) Decline of serum antimullerian hormone levels after laparoscopic ovarian cystectomy in endometrioma and other benign cysts: a prospective cohort study. Fertil Steril. 101:435–441 Goodman LR, Goldberg JM, Flyckt RL, Gupta M, Harwalker J, Falcone T (2016) Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am J Obstet Gynecol. 215:e581-589 Urman B, Alper E, Yakin K, Oktem O, Aksoy S, Alatas C, Mercan R, Ata B (2013) Removal of unilateral endometriomas is associated with immediate and sustained reduction in ovarian reserve. Reprod Biomed Online. 27:212–216 Celik HG, Dogan E, Okyay E, Ulukus C, Saatli B, Uysal S, Koyuncuoglu M (2012) Effect of laparoscopic excision of endometriomas on ovarian reserve: serial changes in the serum antimullerian hormone levels. Fertil Steril. 97:1472–1478 Fouda UM, Elsetohy KA, Elshaer HS (2016) Barbed versus conventional suture: a randomized trial for suturing the endometrioma bed after laparoscopic excision of ovarian endometrioma. J Minim Invasive Gynecol. 23:962–968 Younis JS, Shapso N, Ben-Sira Y, Nelson SM, Izhaki I (2022) Endometrioma surgery-a systematic review and meta-analysis of the effect on antral follicle count and anti-Mullerian hormone. Am J Obstet Gynecol. https://doi.org/10.1016/j.ajog.2021.06.102

We appreciate YingYing Zhu for her help in the language editing and statistical guidance of the manuscript. Funding This work was supported by Sun Yat-Sen University Clinical Research 5010 Program (2017014). Author information Authors and Affiliations Contributions SFC Protocol development, data collection and analysis, management, manuscript writing. DMC data collection and management. LAW management, manuscript editing. MQX Protocol development, management, manuscript editing and supervision. All authors critically reviewed the content and approved the final version of the work. Corresponding author Ethics declarations Conflict of interests The authors declare that they have no conflict of interest. Ethical approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the institutional review board (IRB) of Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University (Approval number: SYSEC-KY-KS-2022–035). In view of the retrospective nature of the study and all the procedures performed were part of routine care, obtaining informed consent from the patients was waived. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Chen, S., Chen, D., Wang, L. et al. Gauze packing may be a better hemostatic method to protect ovarian reserve during laparoscopic endometrioma cystectomy than conventional hemostatic methods. Arch Gynecol Obstet 308, 927–934 (2023). https://doi.org/10.1007/s00404-023-07088-4 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-023-07088-4