Ovarian Endometrioma: Postoperative Adhesions following Bipolar Coagulation and Suture

M. Pellicano, M.D., S. Bramante, M.D., M. Guida, M.D., G. Bifulco, M.D., A. Di Spiezio Sardo, M.D.,
D. Cirillo, M.D., and C. Nappi, M.D.
Department of Obstetrics and Gynecology, University of Naples ‘‘Federico II,’’ Naples, Italy

Objective: To compare bipolar coagulation and suturing of the ovary in terms of postoperative ovarian adhesions
after laparoscopic ovarian cystectomy for endometriosis.

Design: Prospective, randomized, controlled study.

Setting: Department of Obstetrics and Gynecology, University of Naples ‘‘Federico II.’’
Patient(s): Thirty-two women with a single endometriotic cyst were randomly divided into two groups of 16
women each (groups A and B).

Intervention(s): All patients underwent laparoscopic ovarian cystectomy for endometriosis. In group A, hemostasis
was performed by closure of the ovary with an intraovarian suture. In group B, complete hemostasis was
achieved only with bipolar coagulation on the internal face of the ovary.

Main Outcome Measure(s): Rate and extension of postsurgical ovarian adhesions at 60–90 days follow-up.
Result(s): At follow-up, a significantly lower rate of postsurgical ovarian adhesions was observed in group A than
in group B (30.8% vs. 57.1%). The extension of ovarian adhesions was significanlty higher in group B than in group A.

Conclusion(s): The use of sutures on ovaries treated for endometrioma is associated with a lower rate of postoperative
ovarian adhesion formation compared with bipolar coagulation. (Fertil Steril 2008;89:796–9. 2008 by
American Society for Reproductive Medicine.)

Key Words: Endometriosis, laparoscopy, ovarian cyst, adhesion, prevention

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