Grand Rounds

Hemostatic Sealant vs Electrocoagulation Following Laparoscopic Endometrioma Cystectomy: Effect on Ovarian Reserve

BACKGROUND AND PURPOSE:

Previous studies comparing hemostatic techniques used AMH to assess ovarian reserve, which may not be as accurate as antral follicle count (AFC)
- Hormone secretion by non-operated ovary may mask reduced reserve of ovary undergoing surgery
Chung et al. (BJOG, 2019) evaluated the effect of hemostatic sealant compared to bipolar coagulation on ovarian reserve following laparoscopic cystectomy using AFC

Randomized controlled trial (RCT)
- Participants and sonographers were blinded to exposure
Participants
- Women aged 18-40 years
- 3–8 cm unilateral or bilateral endometriomas
- No previous surgery or history of hormonal therapy 6 months prior to surgery
Surgery
- Laparoscopic cystectomy using the ‘stripping method’
Exposures
- Hemostasis by the application of hemostatic sealant (FloSeal)
- Standard care (bipolar coagulation)
Primary outcomes
- Change in AFC 3 months after the operation
Secondary outcomes
- Change in AMH and FSH
- Peri-operative outcomes: Hemostasis | Complications | Pain | Satisfaction scores

94 patients: 47 in each group
- Mean age: 32.36 years
- Mean endometrioma diameter: 4.21 cm

Primary outcome: AFC

In both groups, AFC at 1 and 3 months post-op were both higher than baseline
There was a significantly greater increase in AFC with hemostatic sealant group at 3 months (P = 0.013)
- Sealant (mean and SD): +2.36 ± 0.37
- Control: +1.08 ± 0.36
- Unoperated ovary: No change in AFC
There was no significant difference between the groups for
- AMH and FSH
- Operative details (time, blood loss) | Postoperative complications | Recovery | Pain scores

While impact of sealant is modest, may be clinically important, especially for women who may be at risk for ovarian reserve compromise such as older women
Hemostatic sealant should be considered as an alternative to bipolar coagulation for laparoscopic cystectomy for endometriosis

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