Laparoskopik endometrioma kistektomi cerrahilerinde elektrokoagülasyon veya sütür tekniği ile sağlanan hemostazın rekürrens ve gebelik sağlama oranına etkisi

Amaç: Bu çalışmanın amacı, tek veya bilateral endometriomalarda laparoskopik kistektomi sonrası elektrokoagülasyon veya sütür tekniği uygulaması ile sağlanan hemostazın, endometrioma rekürrensi ve spontan gebelik oranlarına etkisinin değerlendirilmesidir.Gereç ve Yöntem: 18-42 yaş aralığında herhangi bir yardımcı üreme tedavisi desteği almayan 46 primer infertil hasta retrospektif olarak analiz edildi. Laparoskopik kistektomi operasyonu, sıyırma tekniği ile uygulandı. Over doku kanaması sütür (n=23) veya bipolar elektrokoagülasyon (n=22) ile kontrol edildi. Kist rekürrensi postoperatif olarak ultrason eşliğinde değerlendirildi. Spontan gebelik adet gecikmesi sonrası kan Beta- insan koryonik gonadotropin (B-hCG) seviyesi bakılarak saptandı.Bulgular: Ortalama yaş 31.62±6.55 olarak saptandı. Gruplar arasında istatistiksel olarak yaş, vücut kitle indeksi (BMI), preopertaif endometrioma büyüklüğü, pre/postoperatif hemoglobin (hb) ve hemotokrit (Hct) değeri ile anlamlı bir fark saptanmadı. Sütür grubunda rekürrens oranı fazla çıksa da istatistiksel olarak anlamlı bulunmadı. Spontan gebelik oranı her iki grupta benzer saptandı. Çalışma gruplarında endometrioma lateralitesinde istatistiksel olarak bir fark saptanmadı.Sonuç: Bu çalışma, Endometrioma cerrahisi sonrası uygulanan elektrokoagülasyon veya sütür tekniğinin endometrioma rekürrensi ve spontan gebelik oranlarına farklı etkisinin olmadığını göstermiştir.

Anahtar Kelimeler:

endometriozis, rekürrens, hemostaz, kistektomi

The effect of hemostasis by electrocoagulation versus suture on endometrioma recurrence and pregnancy rates after laparoscopic cystectomy in endometriomas

Purpose: The aim of this study was to assess the effect of hemostasis by electrocoagulation versus suture on endometrioma recurrence and pregnancy rates after laparoscopic cystectomy in uni/bilateral endometriomas. Materials and Methods: Forty-six primary infertile patients wishing to conceive without any assisted reproductive treatments, between 18 and 42 years, with uni/bilateral endometriomas were retrospectively analyzed. Laparoscopic cystectomies were performed by the stripping method. Ovarian hemostasis was obtained either by suturing (n = 23) or by bipolar electrocoagulation (n = 22). Cyst recurrence was evaluated by postoperative ultrasound scan. Pregnancy was confirmed by serum Beta-human choronic gonadotropin (B-hCG) levels if the patient presented with menstrual delay. Results: The mean of age of the patients was 31.62±6.55 years old. There was no significant difference between study groups regarding age, body mass index (BMI), preoperative endometrioma size, or pre/post-operative hemoglobin/hematocrite (Hb/Htc) levels. The recurrence rate was higher in the electrocoagulation group than the suturing group; however, the difference was not statistically significant. The spontaneous pregnancy rates were also similar between study groups. There was no significant difference between study groups considering unilaterality or bilaterality of endometriomas. Conclusion: Our preliminary data show that an operation on ovarian endometriomas-either electrocoagulation or suturing-may not affect endometrioma recurrence or spontaneous pregnancy rate.

Keywords:

endometriosis, recurrence, haemostasis, cystectomy,

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1. De Ziegler D, Borghese B, Chapron C. Endometriosis and infertility: pathophysiology and management. Lancet. 2010;376:730-8.
2. Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev. 2008;16:CD004992.
3. Vercellini P, Chapron C, De Giorgi O, Consonni D, Frontino G, Crosignani PG. Coagulation or excision of ovarian endometriomas?. 2003;188:606-10.
4. Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012;97:3146-54.
5. Somigliana E, Berlanda N, Benaglia L, Vigano P, Vercellini P, Fedele L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertil Steril. 2012;98:1531-8.
6. Var T, Batioglu S, Tonguc E, Kahyaoglu I. The effect of laparoscopic ovarian cystectomy versus coagulation in bilateral endometriomas on ovarian reserve as determined by antral follicle count and ovarian volume: a prospective randomized study. Fertil Steril. 2011;95:2247-50.
7. Hirokawa W, Iwase A, Goto M, Takikawa S, Nagatomo Y, Bayasula B et al. The post-operative decline in serum anti- Mullerian hormone correlates with the bilaterality and severity of endometriosis. Hum Reprod. 2011;26:904-10.
8. Fedele L, Bianchi S, Zanconato G, Bergamini V, Berlanda N. Bipolar electrocoagulation versus suture of solitary ovary after laparoscopic excision of ovarian endometriomas. J Am Assoc Gynecol Laparosc. 2004;11:344-7.
9. Song T, Kim WY, Lee KW, Kim KH. Effect on ovarian reserve of hemostasis by bipolar coagulation versus suture during laparoendoscopic single-site cystectomy for ovarian endometriomas. J Minim Invasive Gynecol. 2015;22:415-20.
10. Coric M, Barisic D, Pavicic D, Karadza M, Banovic M. Electrocoagulation versus suture after laparoscopic stripping of ovarian endometriomas assessed by antral follicle count: preliminary results of randomized clinical trial. Arch Gynecol Obstet. 2011;283:373-8.
11. Deckers P, Ribeiro CS, Simoes 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 Gynecol Obstet. 2018;140:11-7.
12. Mais V, Guerriero S, Ajossa S, Angiolucci M, Paoletti AM, Melis GB. The efficiency of transvaginal ultrasonography in the diagnosis of endometrioma. Fertil Steril. 1993;60:776-80.
13. Littman E, Giudice L, Lathi R, Berker B, Milki A, Nezhat C. Role of laparoscopic treatment of endometriosis in patients with failed in vitro fertilization cycles. Fertil Steril. 2005;84:1574-8.
14. Reich H, Abrao MS. Post-surgical ovarian failure after laparoscopic excision of bilateral endometriomas: is this rare problem preventable? Am J Obstet Gynecol. 2006;195:339-40.
15. Ferrero S, Venturini PL, Gillott DJ, Remorgida V, Maggiore ULR. Hemostasis by bipolar coagulation versus suture after surgical stripping of bilateral ovarian endometriomas: a randomized controlled trial. J Minim Invasive Gynecol. 2012;19:722-30.
16. Asgari Z, Rouholamin S, Hosseini R, Sepidarkish M, Hafizi L, Javaheri A. Comparing ovarian reserve after laparoscopic excision of endometriotic cysts and hemostasis achieved either by bipolar coagulation or suturing: A randomized clinical trial. Arch Gynecol Obstet. 2016;293:1015-22.
17. Takashima A, Takeshita N, Otaka K, Kinoshita T. Effects of bipolar electrocoagulation versus suture after laparoscopic excision of ovarian endometrioma on the ovarian reserve and outcome of in vitro fertilization. J Obstet Gynaecol Res. 2013;39:1246-52.
18. Ata B, Turkgeldi B, Seyhan A, Urman B. Effect of hemostatic method on ovarian reserve following laparoscopic endometrioma excision; comparison of suture, hemostatic sealant, and bipolar dessication. A systematic review and meta-analysis. J Minim Invasıve Gynecol. 2015;22:363-72.
19. Sugita A, Iwase A, Goto M, Nakahara T, Nakamura T, Kondo M et al. One-year follow-up of serum antimüllerian hormone levels in patients with cystectomy: are different sequential changes due to different mechanisms causing damage to the ovarian reserve? Fertil Steril. 2013;100:516-22.e3.
20. Uncu G, Kasapoglu I, Ozerkan K, Seyhan A, Oral Yılmaztepe A, Ata B. Prospective assessment of the impact on endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve. Hum Reprod. 2103;28:2140-5.
21. Alio L, Angioni S, Arena S, Bartiromo L, Bergamini V, Berlanda N et al. Endometriosis: seeking optimal management in women approaching menopause. Climacteric. 2019;22:329-38.
22. Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril. 1998;70:1176– 80.
23. Alborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zolghadri J, Alborzi S. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril. 2004;82:1633–7.
24. Toner JP, Seifer DB. Why we may abandon basal follicle-stimulating hormone testing: a sea change in determining ovarian reserve using antimüllerian hormone. Fertil Steril. 2013;99:1825-30.