Deckers P, Ribeiro SC, Simões RDS, Miyahara CBDF, Baracat EC. Systematic review and meta-analysis of the effect of bipolar electrocoagulation during laparoscopic ovarian endometrioma stripping on ovarian reserve.
Int J Gynaecol Obstet 2017;
140:11-17. [PMID:
28980317 DOI:
10.1002/ijgo.12338]
[Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/16/2017] [Accepted: 10/02/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND
Laparoscopic stripping is the gold-standard treatment for ovarian endometriosis. The choice of hemostasis method might affect ovarian reserve.
OBJECTIVES
To determine whether bipolar electrocoagulation is more detrimental to ovarian reserve than non-thermal hemostasis methods.
SEARCH STRATEGY
Entry terms associated with the MeSH terms "endometrioma," "laparoscopy," and "ovarian reserve" were used to search databases for articles published up to April 3, 2017, in English, Spanish, Portuguese, French, and Italian.
SELECTION CRITERIA
Randomized controlled trials comparing the 3-month postoperative serum anti-Müllerian hormone (AMH) level in premenopausal women undergoing laparoscopic stripping with bipolar hemostasis or non-thermal hemostasis methods were selected.
DATA COLLECTION AND ANALYSIS
Data were extracted by two independent reviewers and a meta-analysis was performed.
MAIN RESULTS
Three studies met the inclusion criteria; overall, 105 patients underwent surgery with bipolar electrocoagulation and 105 patients underwent surgery with an alternative hemostasis method. The AMH level 3 months after surgery was decreased in the bipolar electrocoagulation group (mean difference -0.79 ng/mL, 95% confidence interval -1.19 to -0.39).
CONCLUSIONS
Bipolar electrocoagulation negatively impacts ovarian reserve and should be avoided, especially for patients with reproductive goals.
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