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

METHODS:

• 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

RESULTS:

• 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

CONCLUSION:

• 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

Learn More – Primary Sources:

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

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Does Vasopressin Injection Reduce Risk of Reduced Ovarian Reserve During Surgery for Bilateral Endometriomas?

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Do AMH Levels Truly Predict Ovarian Reserve in Women Over 30?

Results from the LAROSE Study: Robotic Surgery vs Laparoscopy for Endometriosis

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