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

Abstract

The aim of this study was to assess the effect of ovarian suspension to the round ipsilateral ligament with a resorbable suture, performed during laparoscopic surgery for endometrioma, on postoperative ovarian adhesion formation. The tool used to assess this effect was not conventional laparoscopy but outpatient transvaginal hydrolaparoscopy. Fifty women with single ovarian endometrioma were divided in two groups (group A, 24 and group B, 26). All patients underwent laparoscopic ovarian cystectomy for endometriosis. In group A, the ovary was suspended to the ipsilateral round ligament. In group B, ovarian suspension was not performed. All patients underwent transvaginal outpatient hydrolaparoscopy as follow-up. A significantly lower rate of postsurgical ovarian adhesion in group A in comparison with group B (33.3 vs 80.8 %-p=0.001) was observed. Operative time and postoperative pain were similar in both groups. Ovarian suspension to the ipsilateral round ligament with a resorbable suture during surgery for endometrioma is associated with a lower rate of postoperative ovarian adhesion formation.

Safety and Efficacy of Two Techniques of Temporary Ovarian Suspension to the Anterior Abdominal Wall after Operative Laparoscopy

“…Redwine, (2001) proposed TOS to the round ligament after operative laparoscopy for severe endometriosis using 3-0 Vicryl suture in patients with chronic pelvic pain secondary to severe endometriosis (Redwine, 2001). Similarly, Pellicano et al, (2014) reported that suspending the ovary to the ipsilateral round ligament using Vicryl Rapid 2.0 CT-1 needle after excision of an endometrioma resulted in significantly lower rate of postsurgical ovarian adhesion as judged by post- operative transvaginal outpatient hydro-laparoscopy (Pellicano et al, 2014). This technique of suspending the ovary to the round ligament, in theory, carries the risk of adhesion formation between these structures which certainly alters the normal anatomy and in turn may reduce fertility potential during natural attempts at achieving pregnancy.…”

“…A thorough search of literature revealed that there are only 11 manuscripts and 1 published abstract addressing the safety and efficacy of TOS. There are 8 observational studies (7 manuscripts and 1 published abstract) [Abuzeid M et al, 2002; Quahba et al, 2004; Carbonnel et al 2011; Poncelet et al, 2012; Pellicano et al, 2014; Trehan A and Trehan AK 2014; Abuzeid O et al, 2018, Mitwally et al, 2009], 2 systematic reviews (Pergialiotis et al, 2016; Giampaolino et al, 2018), and 2 prospective randomized control trials (Seracchioli et al, 2014; Hoo et al, 2014).…”

“…Ovarian suspension techniques have been proposed after ovariolysis and excision of endometrioma to reduce occurrence and recurrence of adhesions. Over the last 15 years many groups published their experience with temporary ovarian suspension (TOS) for various indications and by various techniques (Lee et al, 1995; Quahba et al, 2004; Mitwally et al, 2006; Chapman et al, 2007; Carbonnel et al, 2011; Poncelet et al, 2012; Pellicano et al, 2014; Pergialiotis et al, 2016). More recently, Abuzeid O et al (2018) published a video describing a modified technique to temporary suspend the ovary to the fascia of the anterior abdominal wall using an absorbable suture with 3-0 plain catgut (Abuzeid O et al, 2018).…”

Role of Ovarian Suspension in Preventing Postsurgical Ovarian Adhesions in Patients with Stage III-IV Pelvic Endometriosis: A Systematic Review

“…The primary outcome included the prevalence and the severity of ovarian adhesions after ovarian suspension, defined as the total number of adhesions affecting the ovaries and evaluated by means of transvaginal ultrasound (TVU) [16,22,24À26], laparoscopy (LPS) [22,27,28], or transvaginal hydrolaparoscopy (TV-H-LPS) [29]. The severity of ovarian adhesions was graded using the Operative Laparoscopy Study Group (OLSG) criteria (0, no adhesion; 1, smooth and avascular; 2, dense or vascular; 3, cohesive) and the revised American Fertility Society scoring system.…”

“…These 8 studies included 2 RCTs [16,28],1 pilot RCT [15], and 5 NRSs [17,22,26,27,29] (Table 1). The NRSs included 4 retrospective studies [17,22,26,27] and 1 prospective cohort study [29]. A total of 795 patients were examined in the 8 studies.…”