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Electrocoagulation versus suture after laparoscopic stripping of ovarian endometriomas assessed by antral follicle count: preliminary results of randomized clinical trial

  • Reproductive Medicine
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The assessment of ovarian reserve by antral follicle count (AFC) following electrocoagulation versus suture after laparoscopic stripping of ovarian endometriomas.

Methods

Forty-five patients between 18 and 35 years, with unilateral endometriomas were randomly analyzed. Laparoscopic cystectomy was performed by the stripping method. Ovarian hemostasis was obtained either by suturing (group A, n = 23) or by bipolar electrocoagulation (group B, n = 22). AFC was performed by ultrasound on the third day of the three postoperative menstrual cycles. The sum of AFC was compared between sutured (A1) and electrocoagulated (B1) ovaries, as well as between intact ovaries of both groups (A0: intact ovaries in sutured group, B0: intact ovaries in electrocoagulated group).

Results

The median of AFC was significantly lower in operated ovaries than in intact ovaries in both groups of patients, regardless of suturing [A1 median: 12 (range 9–19) vs. A0 median: 21.0 (range 15–27), p < 0.05] or electrocoagulation [B1: 5.0 (2–10) vs. B0: 18.5 (8–29), p < 0.05]. The median AFC was significantly higher in sutured ovaries than in electrocoagulated ovaries [A1: 12 (9–19) vs. B1: 5.0 (2–10), p < 0.05].

Conclusion

Our preliminary data show that operation on ovarian endometriomas could reduce ovarian reserve. The AFC value suggests that the ovarian reserve was less reduced in sutured ovaries than in those electrocoagulated. Suturing as a method of hemostasis could be a better choice after stripping ovarian endometriomas.

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References

  1. Gupta S, Goldberg JM, Aziz N, Goldberg E, Krajcir N, Agarwal A (2008) Pathogenic mechanisms in endometriosis-associated infertility. Fertil Steril 90(2):247–257

    Article  CAS  PubMed  Google Scholar 

  2. Lemos NA, Arbo E, Scalco R, Weiler E, Rosa V, Cunha-Filho JS (2008) Decreased anti-Müllerian hormone and altered ovarian follicular cohort in infertile patients with mild/minimal endometriosis. Fertil Steril 89(5):1064–1068

    Article  CAS  PubMed  Google Scholar 

  3. Practice Committee of the American Society for Reproductive Medicine (2006) Endometriosis and infertility. Fertil Steril 86(5 Suppl):S156–S160

    Google Scholar 

  4. Jones KD, Sutton CJ (2000) Laparoscopic management of ovarian endometriomas: a critical review of current practice. Curr Opin Obstet Gynecol 12(4):309–315

    Article  CAS  PubMed  Google Scholar 

  5. Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P (1998) Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril 70:1176–1180

    Article  CAS  PubMed  Google Scholar 

  6. Muzii L, Bianchi A, Crocè C, Manci N, Panici PB (2002) Laparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure? Fertil Steril 77(3):609–614

    Article  PubMed  Google Scholar 

  7. Alborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zolghadri J, Alborzi S (2004) A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril 82(6):1633–1637

    Article  PubMed  Google Scholar 

  8. Yeung PP Jr, Shwayder J, Pasic RP (2009) Laparoscopic management of endometriosis: comprehensive review of best evidence. J Minim Invasive Gynecol 16(3):269–281

    Article  PubMed  Google Scholar 

  9. Fedele L, Bianchi S, Zanconato G, Bergamini V, Berlanda N (2004) Bipolar electrocoagulation versus suture of solitary ovary after laparoscopic excision of ovarian endometriomas. Am Assoc Gynecol Laparosc 11(3):344–347

    Article  Google Scholar 

  10. Exacoustos C, Zupi E, Amadio A et al (2004) Laparoscopic removal of endometriomas: sonographic evaluation of residual functioning ovarian tissue. Am J Obstet Gynecol 191(1):68–72

    Article  PubMed  Google Scholar 

  11. Barnhart K, Dunsmoor-Su R, Coutifaris C (2002) Effect of endometriosis on in vitro fertilization. Fertil Steril 77(6):1148–1155

    Article  PubMed  Google Scholar 

  12. Hansen KR, Hodnett GM, Knowlton N, Craig LB (2010) Correlation of ovarian reserve tests with histologically determined primordial follicle number. Fertil Steril (in press)

  13. Chow GE, Criniti AR, Soules MR (2004) Antral follicle count and serum follicle-stimulating hormone levels to assess functional ovarian age. Obstet Gynecol 104(4):801–804

    Article  PubMed  Google Scholar 

  14. Soldevila PN, Carreras O, Tur R, Coroleu B, Barri PN (2007) Sonographic assessment of ovarian reserve. Its correlation with outcome of in vitro fertilization cycles. Gynecol Endocrinol 23(4):206–212

    Article  PubMed  Google Scholar 

  15. Erdem M, Erdem A, Guler I, Atmaca S (2008) Role of antral follicle count in controlled ovarian hyperstimulation and intrauterine insemination cycles in patients with unexplained subfertility. Fertil Steril 90(2):360–366

    Article  PubMed  Google Scholar 

  16. Pados G, Tsolakidis D, Assimakopoulos E, Athanatos D, Tarlatzis B (2010) Sonographic changes after laparoscopic cystectomy compared with three-stage management in patients with ovarian endometriomas: a prospective randomized study. Hum Reprod 25(3):672–677

    Article  PubMed  Google Scholar 

  17. Jayaprakasan K, Campbell B, Hopkisson J, Clewes J, Johnson I, Raine-Fenning N (2008) Establishing the intercycle variability of three-dimensional ultrasonographic predictors of ovarian reserve. Fertil Steril 90(6):2126–2132

    Article  PubMed  Google Scholar 

  18. Muzii L, Bellati F, Bianchi A, Palaia I, Manci N, Zullo MA et al (2005) Laparoscopic stripping of endometriomas: a randomized trial on different surgical techniques. Part II: pathological results. Hum Reprod 20(7):1987–1992

    Article  PubMed  Google Scholar 

  19. Hachisuga T, Kawarabayashi T (2002) Histopathological analysis of laparoscopically treated ovarian endometriotic cysts with special reference to loss of follicles. Hum Reprod 17(2):432–435

    Article  PubMed  Google Scholar 

  20. Benaglia L, Somigliana E, Vighi V, Ragni G, Vercellini P, Fedele L (2010) Rate of severe ovarian damage following surgery for endometriomas. Hum Reprod 25(3):678–682

    Article  PubMed  Google Scholar 

  21. Hart RJ, Hickey M, Maouris P, Bucket W (2008) Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 3:CD004992

    Google Scholar 

  22. Donnez J, Nisolle M, Gillet N, Smets M, Bassil S, Casanas-Roux F (1996) Large ovarian endometriomas. Hum Reprod 11:641–646

    CAS  PubMed  Google Scholar 

  23. Tsolakidis D, Pados G, Vavilis D, Athanatos D, Tsalikis T, Giannakou A, Tarlatzis BC (2010) The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril 94(1):71–77

    Article  CAS  PubMed  Google Scholar 

  24. Pellicano M, Bramante S, Guida M, Bifulco G, Di Spiezio Sardo A, Cirillo D, Nappi C (2008) Ovarian endometrioma: postoperative adhesions following bipolar coagulation and suture. Fertil Steril 89:796–799

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Dr. Ludovico Muzii for an initial support.

Conflict of interest

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Authors and Affiliations

  1. Department of Gynecological Surgery, Zagreb University Hospital Center, Petrova 13, 10 000, Zagreb, Croatia

    Mario Coric, Dubravko Barisic, Dinka Pavicic, Magdalena Karadza & Maja Banovic

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  1. Mario Coric
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  2. Dubravko Barisic
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  3. Dinka Pavicic
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  4. Magdalena Karadza
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  5. Maja Banovic
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Correspondence to Mario Coric.

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Coric, M., Barisic, D., Pavicic, D. et al. Electrocoagulation versus suture after laparoscopic stripping of ovarian endometriomas assessed by antral follicle count: preliminary results of randomized clinical trial. Arch Gynecol Obstet 283, 373–378 (2011). https://doi.org/10.1007/s00404-010-1676-x

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  • DOI: https://doi.org/10.1007/s00404-010-1676-x

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