Ovarian Reserve and Recurrence at One-Year Postoperatively after using Haemostatic Sealant and Bipolar Diathermy for Haemostasis during Laparoscopic Ovarian Cystectomy

Abstract Research Question Is there a difference in the ovarian reserve at one -year postoperatively in those who used a haemostatic sealant or bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy for ovarian endometriomas? Design This was an extended follow-up observational study of a previous randomised controlled trial where women aged 18 to 40 years with 3-8cm unilateral or bilateral endometriomas were randomised to receive haemostasis by a haemostatic sealant or bipolar diathermy following ovarian cystectomy. The primary outcome was the ovarian reserve as assessed by antral follicle count (AFC) at one year postoperatively. Secondary outcomes included the recurrence rate of ovarian endometrioma, the change anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) levels and reproductive outcomes. Results The significant increase in AFC at 3 months after initial surgery in the haemostatic sealant group compared to diathermy group was sustained at one year but there was no difference in AMH and FSH levels between the groups throughout the follow-up period. The recurrence rate in the FloSeal group (7.7 %, n=3/39) appeared lower than that of the diathermy group (22.2%, n =8/36) although the difference did not reach statistical significance (p= 0.060). The recurrence rate in women who had bilateral lesions was significantly higher than those with unilateral lesions (RR5.33, 1.55-18.38). No difference in reproductive outcomes was found between the two groups. Conclusions Applying haemostatic sealant after laparoscopic cystectomy of ovarian endometriomas produces a significantly greater improvement in AFC, which was apparent at 3-month follow-up, was sustained at 1-year follow-up without comprising the recurrence rate.