Skip to main content
Log in

Ovarian suspension for adhesion prevention during laparoscopic excision of severe pelvic endometriosis and endometrioma excision: a systematic review

  • Review Article
  • Published:
Gynecological Surgery

Abstract

Ovarian adhesions are fibrous connections, which develop between the ovaries and the surrounding organs as a result of a prior traumatic surgery in this area. Several studies suggest ovarian suspension as a way to prevent them; however, to date, there is no consensus regarding its effectiveness in the field. To investigate whether the application of ovarian suspension would be beneficial in the prevention of postoperative ovarian adhesions. We used Medline (1966–2015), Scopus (2004–2015), ClinicalTrials.gov (2008–2015), Cochrane Central Register of Controlled Trials (CENTRAL; 1999–2015), and Google Scholar (2004–2015) search engines in our primary search, together with reference lists from included studies. Four studies were included in our systematic review, which recruited 105 women of fertile age. The rates of absence of adhesions were between 41 and 80 %. In their majority, adhesions were mild whenever reported, with the exception of the study of Ouahba et al. who found that adhesions of moderate severity had an incidence of 33 %. None of the included studies reported the incidence of preoperative and postoperative symptoms. Current evidence suggests that ovarian suspension could be an effective and feasible surgical technique, which might actually help reduce postoperative adhesions. However, future research is needed in this field, as the number of studies published in this field is relatively small to reach firm conclusions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Ahn SH, Monsanto SP, Miller C et al (2015) Pathophysiology and immune dysfunction in endometriosis. Biomed Res Int 2015:795976

    PubMed  PubMed Central  Google Scholar 

  2. Bruner-Tran KL, Herington JL, Duleba AJ et al (2013) Medical management of endometriosis: emerging evidence linking inflammation to disease pathophysiology. Minerva Ginecol 65:199–213

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Grammatikakis I, Trompoukis P, Zervoudis S et al (2015) Laparoscopic treatment of 1522 adnexal masses: an 8-year experience. Diagn Ther Endosc 2015:979162

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. De Wilde RL, Brolmann H, Koninckx PR et al (2012) Prevention of adhesions in gynaecological surgery: the 2012 European field guideline. Gynecol Surg 9:365–368

    Article  PubMed  PubMed Central  Google Scholar 

  5. Robertson D, Lefebvre G, Leyland N et al (2010) Adhesion prevention in gynaecological surgery. J Obstet Gynaecol Can 32:598–608

    Article  PubMed  Google Scholar 

  6. Ray GR, Trueblood HW, Enright LP et al (1970) Oophoropexy: a means of preserving ovarian function following pelvic megavoltage radiotherapy for Hodgkin’s disease. Radiology 96:175–180

    Article  CAS  PubMed  Google Scholar 

  7. Cutner AS, Lazanakis MS, Saridogan E (2004) Laparoscopic ovarian suspension to facilitate surgery for advanced endometriosis. Fertil Steril 82:702–704

    Article  PubMed  Google Scholar 

  8. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  PubMed  PubMed Central  Google Scholar 

  9. Howick J, Chalmers IG, Greenhalgh PT et al. OCEBM levels of evidence working group*. “The Oxford levels of evidence 2”. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653

  10. Guyatt G, Oxman AD, Akl EA et al (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394

    Article  PubMed  Google Scholar 

  11. Poncelet C, Ducarme G, Yazbeck C et al (2012) Safety of transient abdominal ovariopexy in patients with severe endometriosis. Int J Gynaecol Obstet 118:120–122

    Article  PubMed  Google Scholar 

  12. Hoo WL, Stavroulis A, Pateman K et al (2014) Does ovarian suspension following laparoscopic surgery for endometriosis reduce postoperative adhesions? An RCT. Hum Reprod 29:670–676

    Article  PubMed  Google Scholar 

  13. Seracchioli R, Di Donato N, Bertoldo V et al (2014) The role of ovarian suspension in endometriosis surgery: a randomized controlled trial. J Minim Invasive Gynecol 21:1029–1035

    Article  PubMed  Google Scholar 

  14. Carbonnel M, Ducarme G, Dessapt AL et al (2011) Efficacy of transient abdominal ovariopexy in patients with severe endometriosis. Eur J Obstet Gynecol Reprod Biol 155:183–187

    Article  PubMed  Google Scholar 

  15. Abuzeid MI, Ashraf M, Shamma FN (2002) Temporary ovarian suspension at laparoscopy for prevention of adhesions. J Am Assoc Gynecol Laparosc 9:98–102

    Article  PubMed  Google Scholar 

  16. Ouahba J, Madelenat P, Poncelet C (2004) Transient abdominal ovariopexy for adhesion prevention in patients who underwent surgery for severe pelvic endometriosis. Fertil Steril 82:1407–1411

    Article  PubMed  Google Scholar 

  17. Pellicano M, Giampaolino P, Tommaselli GA et al (2014) Efficacy of ovarian suspension to round ligament with a resorbable suture to prevent postoperative adhesions in women with ovarian endometrioma: follow-up by transvaginal hydrolaparoscopy. Gynecol Surg 11:261–266

    Article  Google Scholar 

  18. Berker B, Seval M (2015) Problems with the diagnosis of endometriosis. Women’s Health (Lond Engl) 11:597–601

    Article  CAS  Google Scholar 

  19. Duffy JM, Arambage K, Correa FJ et al (2014) Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev 4:CD011031

    Google Scholar 

  20. Lower AM, Hawthorn RJ, Ellis H et al (2000) The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological operations: an assessment from the Surgical and Clinical Adhesions Research Study. BJOG 107:855–862

    Article  CAS  PubMed  Google Scholar 

  21. Vrijland WW, Jeekel J, van Geldorp HJ et al (2003) Abdominal adhesions: intestinal obstruction, pain, and infertility. Surg Endosc 17:1017–1022

    Article  CAS  PubMed  Google Scholar 

  22. Practice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons (2013) Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery: a committee opinion. Fertil Steril 99:1550–1555

    Article  Google Scholar 

  23. Gutt CN, Oniu T, Schemmer P et al (2004) Fewer adhesions induced by laparoscopic surgery? Surg Endosc 18:898–906

    Article  CAS  PubMed  Google Scholar 

  24. Baakdah H, Tulandi T (2005) Adhesion in gynecology complication, cost, and prevention: a review. Surg Technol Int 14:185–190

    PubMed  Google Scholar 

  25. Pados G, Venetis CA, Almaloglou K et al (2010) Prevention of intra-peritoneal adhesions in gynaecological surgery: theory and evidence. Reprod Biomed Online 21:290–303

    Article  CAS  PubMed  Google Scholar 

  26. Ahmad G, O’Flynn H, Hindocha A et al (2015) Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev 4:CD000475

    Google Scholar 

  27. Ahmad G, Mackie FL, Iles DA et al (2014) Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev 7:CD001298

    Google Scholar 

  28. Pados G, Makedos A, Tarlatzis B (2013) Adhesion prevention strategies in laparoscopic surgery, endoscopy. InTech; Available from: http://www.intechopen.com/books/endoscopy/adhesion-prevention-strategies-in-laparoscopic-surgery

  29. Koninckx PR, Corona R, Timmerman D et al (2013) Peritoneal full-conditioning reduces postoperative adhesions and pain: a randomised controlled trial in deep endometriosis surgery. J Ovarian Res 6:1–9

    Article  Google Scholar 

  30. Cheong YC, Laird SM, Li TC et al (2001) Peritoneal healing and adhesion formation/reformation. Hum Reprod Update 7:556–566

    Article  CAS  PubMed  Google Scholar 

  31. Jacobson TZ, Duffy JM, Barlow D et al. (2010) Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev: CD001398

  32. Boujenah J, Bonneau C, Hugues JN et al (2015) External validation of the endometriosis fertility index in a French population. Fertil Steril 104:119–123.e111

    Article  PubMed  Google Scholar 

  33. Centini G, Afors K, Murtada R et al (2015) The impact of laparoscopic surgical management of deep endometriosis on pregnancy rate. J Minim Invasive Gynecol

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vasilios Pergialiotis.

Ethics declarations

Funding

The authors did not receive funding for the present study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pergialiotis, V., Prodromidou, A., Karampetsou, N. et al. Ovarian suspension for adhesion prevention during laparoscopic excision of severe pelvic endometriosis and endometrioma excision: a systematic review. Gynecol Surg 13, 445–450 (2016). https://doi.org/10.1007/s10397-016-0963-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10397-016-0963-3

Keywords

Navigation