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Usefulness of hemostatic sealants for minimizing ovarian damage during laparoscopic cystectomy for endometriosis
Author(s) -
Choi Chahien,
Kim Woo Young,
Lee Dong Hee,
Lee San Hui
Publication year - 2018
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.13542
Subject(s) - medicine , interquartile range , hemostasis , endometriosis , sealant , surgery , anti müllerian hormone , ovarian reserve , laparoscopy , hormone , infertility , pregnancy , chemistry , organic chemistry , biology , genetics
Aim We aimed to evaluate the impact of topical hemostatic sealants and bipolar coagulation during laparoscopic ovarian endometriotic cyst resection on ovarian reserve by comparing the rates of decrease in anti‐Müllerian hormone (AMH). Methods A randomized prospective data collection was made on women aged 19–45 years who planned to have laparoscopic ovarian cystectomy at one of two institutions ( n = 80), Kangbuk Samsung Hospital, Seoul, Korea or National Health Insurance Service Ilsan Hospital, Goyang, Korea, from January 2014 to April 2016. Patients were randomly divided into two groups treated with either a topical hemostatic sealant or bipolar coagulation for hemostasis. The hemostatic group was randomized to the FloSeal or TachoSil subgroups. Preoperative and 3‐month postoperative AMH levels were checked and the rates of decrease of AMH were compared. All patients enrolled were treated with dienogest (Visanne) for 6–12 months. None were lost to follow‐up at postoperative 3 months, but about one‐third of the patients had been lost to follow‐up by 6–12 months. Results AMH was significantly decreased in both groups 3 months postoperatively; however, the rate of decrease in the bipolar coagulation group was greater than that in the hemostatic sealant group, 41.9% (interquartile range [IQR], 22.29–65.24) versus 18.1% (IQR, 10.94–29.90), P = 0.007. Between the two hemostatic subgroups, there was no significant difference in AMH decrease rate, 14.95% (IQR, 11.34–21.21) versus 18.1% (IQR 9.76–40.70), P = 0.204. Conclusion Hemostatic sealants may be an alternative to bipolar coagulation for preservation of ovarian reserve after laparoscopic ovarian cystectomy for endometriosis.