Effectiveness and Safety of Postoperative Medical Treatments Following Fertility-Preserving Surgery for Endometriosis: A Network Meta-Analysis

Background Endometriosis (EMs) is a common gynaecological condition with high recurrence rates after fertility-preserving laparoscopic surgery, and optimal postoperative medical treatment remains unclear.

To evaluate the efficacy and safety of various postoperative medical treatments in reducing recurrence, pain and adverse events in EMs patients after fertility-preserving surgery. Search Strategy PubMed, Web of Science, CENTRAL and Embase databases searched until August 1, 2024. Selection Criteria Randomised controlled trials (RCTs) involving women aged 20–45 years post-fertility-preserving laparoscopic surgery, comparing single postoperative medications with a minimum follow-up of 2 months. Data Collection and Analysis Two reviewers independently extracted data and assessed quality using ROB 2.0 and CINeMA. Bayesian network meta-analysis calculated odds ratios (OR) and mean differences (MD) for recurrence rates, VAS pain reduction and adverse events. Main Results Sixteen RCTs (n = 1605 participants) evaluated 10 drugs: danazol, desogestrel, dienogest, gestrinone, goserelin, leuprolide, LNG-IUS, medroxyprogesterone, oral contraceptives and triptorelin. Only LNG-IUS significantly reduced recurrence rates (OR 0.12, 95% CI 0.02–0.63) and showed the greatest reduction in VAS pain scores (MD −24.96, 95% CI −41.76 to −8.75). Danazol significantly increased weight gain, and goserelin increased hot flashes.

LNG-IUS combined with laparoscopic surgery appears most effective in reducing recurrence and pain in EMs patients. Danazol and goserelin should be used cautiously due to notable adverse effects. Conflicts of Interest The authors declare no conflicts of interest. Data Availability Statement The data that support the findings of this study are available from the corresponding author upon reasonable request. Supporting Information | Filename | Description | |---|---| | bjo70016-sup-0001-AppendixS1.docxWord 2007 document , 22 KB | Appendix S1: bjo70016-sup-0001-AppendixS1.docx. | | bjo70016-sup-0002-AppendixS2.docxWord 2007 document , 25.9 KB | Appendix S2: bjo70016-sup-0002-AppendixS2.docx. | | bjo70016-sup-0003-AppendixS3.docxWord 2007 document , 31.1 KB | Appendix S3: bjo70016-sup-0003-AppendixS3.docx. | | bjo70016-sup-0004-AppendixS4.docxWord 2007 document , 150.8 KB | Appendix S4: bjo70016-sup-0004-AppendixS4.docx. | | bjo70016-sup-0005-AppendixS5.docxWord 2007 document , 31.2 KB | Appendix S5: bjo70016-sup-0005-AppendixS5.docx. | | bjo70016-sup-0006-AppendixS6.docxWord 2007 document , 326.6 KB | Appendix S6: bjo70016-sup-0006-AppendixS6.docx. | | bjo70016-sup-0007-AppendixS7.docxWord 2007 document , 2.6 MB | Appendix S7: bjo70016-sup-0007-AppendixS7.docx. | | bjo70016-sup-0008-AppendixS8.docxWord 2007 document , 528.6 KB | Appendix S8: bjo70016-sup-0008-AppendixS8.docx. | | bjo70016-sup-0009-AppendixS9.docxWord 2007 document , 970.6 KB | Appendix S9: bjo70016-sup-0009-AppendixS9.docx. | | bjo70016-sup-0010-AppendixS10.docxWord 2007 document , 27.1 KB | Appendix S10: bjo70016-sup-0010-AppendixS10.docx. | | bjo70016-sup-0011-AppendixS11.docxWord 2007 document , 278.6 KB | Appendix S11: bjo70016-sup-0011-AppendixS11.docx. | | bjo70016-sup-0012-AppendixS12.docxWord 2007 document , 13.2 KB | Appendix S12: bjo70016-sup-0012-AppendixS12.docx. | | bjo70016-sup-0013-AppendixS13.docxWord 2007 document , 257.9 KB | Appendix S13: bjo70016-sup-0013-AppendixS13.docx. | Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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