Impact of haemostatic sealant versus electrocoagulation on ovarian reserve after laparoscopic ovarian cystectomy of ovarian endometriomas: a randomised controlled trial

Jacqueline Pui Wah Chung, TSM Law, Chs Chung, Jennifer Sze Man Mak, Daljit Singh Sahota, Tin Chiu Li
In: BJOG: An International Journal of Obstetrics & Gynaecology · 2019 · vol. 126(10) , pp. 1267–1275 · doi:10.1111/1471-0528.15807 · PMID:31038276 · W2943590688
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Laparoscopic cystectomy for ovarian endometriomas using haemostatic sealant resulted in a greater increase in antral follicle count at 3 months compared to bipolar coagulation.

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Abstract

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 18-40 years with 3-8 cm unilateral or bilateral endometriomas. METHODS: Ninety-four 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 × time (P = 0.029) for affected ovary antral follicle count. No significant difference was noted between the two groups with regard to follicular-stimulating hormone, anti-Mullerian hormone, and other secondary outcomes. CONCLUSIONS: Applying haemostatic sealant after laparoscopic cystectomy of ovarian endometriomas produced a greater increase in antral follicle count 3 months after surgery compared with the control group. TWEETABLE ABSTRACT: RCT: Haemostatic sealant in laparoscopic cystectomy of endometriomas increase in the antral follicle count after surgery.

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endometrioma

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