A randomized controlled trial of a new technique for laparoscopic management of ovarian endometriosis preventing recurrence and keeping ovarian reserve

Abstract

Introduction Laparoscopic cystectomy provides more favourable outcomes as regards the recurrence and subsequent clinical pregnancy rates. It is associated with significant reduction in the ovarian reserve due to the inevitable removal of unaffected ovarian tissue. The aim of our study was to evaluate the efficiency of Surgicel in preventing recurrence of endometriomas after their laparoscopic conservative management (cystectomy or drainage). Material and methods A randomized controlled trial included two hundred women (candidate for conservative laparoscopic management of ovarian endometriomas). They were randomized into four groups; group D in which patients underwent laparoscopic drainage of the endometrioma, group C in which patients underwent laparoscopic cystectomy of the endometrioma, group DS in which patients underwent laparoscopic drainage followed by insertion of Surgicel inside the cyst cavity & group CS in which patients underwent laparoscopic cystectomy of the endometrioma followed by insertion of Surgicel inside the remaining ovarian tissues. All patients were followed up for 2 years & the primary outcome was the recurrence of endometriomas in the ipsilateral ovary & the postoperative ovarian reserve was reassessed as a secondary outcome. Results The Surgicel-treated groups had significantly lower hazard of recurrence compared to untreated groups ( p = 0.004). Group CS had significantly lower hazard of recurrence compared to Group D & C ( p = 0.014, 0.046 respectively). Group DS had significantly lower hazard of recurrence compared to Group D ( p = 0.039) but it not significantly different from Group C ( p = 0.112). Group DS had the lowest drop of AMH and was significantly lower than the other three groups. Conclusion Surgicel reduces effectively the recurrence risk of endometriomas and its use during laparoscopic drainage is an effective alternative for traditional laparoscopic cystectomy with minimal affection of the patient ovarian reserve. Trial registration Name of the registry: clinicaltrials.gov. Trial registration number NCT02947724 . Date of registration October 28, 2016.

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“…Although it may preserve ovarian reserve, it is not the gold standard for treatment of ovarian endometriomas [16]. Whenever possible, laparoscopic cystectomy should be the first choice, since it can reduce recurrence, raise chance of natural pregnancy and diminish chronic pelvic pain [4,14,23]. Once the cyst wall is tightly adherent to the ovary, complete resection can sometimes be difficult to perform.…”

“…Once the cyst wall is tightly adherent to the ovary, complete resection can sometimes be difficult to perform. If that is the case, it can either lead to destruction of healthy ovarian tissue; or partial resection can leave endometriotic cells at place, raising the chance of recurrence [23].…”

Knockdown of lncRNA H19 suppresses endometriosis in vivo

“…It is defined as the presence and growth of endometrial tissue outside of the uterine cavity and often causes chronic pelvic pain, infertility, menstrual disorders, and pelvic masses ( 3 – 5 ). Endometriosis is a benign disorder but has a high recurrence rate after treatment ( 6 ) and may develop into ovarian endometrioid and clear cell cancer ( 7 , 8 ). Although a number of studies have been carried out to understand the etiology of endometriosis, its detailed pathogenesis remains unclear ( 9 – 13 ).…”

Correlative factors associated with the recurrence of ovarian endometriosis: a retrospective study

“…Previous studies have reported that the recurrence rate of ovarian endometriosis after conservative surgery varies from 6.4% to 43.3% [5,6]. Disease recurrence and repeat surgery increase morbidity and health care costs while significantly damaging ovarian reserve and adversely affecting fertility [7]. Therefore, to prevent the recurrence of ovarian endometriosis after conservative surgical treatment, it is essential to better understand the correlative factors associated with the recurrence of this disease.…”