Systematic review and meta-analysis of the effect of bipolar electrocoagulation during laparoscopic ovarian endometrioma stripping on ovarian reserve

BackgroundLaparoscopic stripping is the gold-standard treatment for ovarian endometriosis. The choice of hemostasis method might affect ovarian reserve. ObjectivesTo determine whether bipolar electrocoagulation is more detrimental to ovarian reserve than non-thermal hemostasis methods. Search strategyEntry 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 criteriaRandomized controlled trials comparing the 3-month postoperative serum anti-Mullerian hormone (AMH) level in premenopausal women undergoing laparoscopic stripping with bipolar hemostasis or non-thermal hemostasis methods were selected. Data collection and analysisData were extracted by two independent reviewers and a meta-analysis was performed. Main resultsThree 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 3months after surgery was decreased in the bipolar electrocoagulation group (mean difference -0.79ng/mL, 95% confidence interval -1.19 to -0.39). ConclusionsBipolar electrocoagulation negatively impacts ovarian reserve and should be avoided, especially for patients with reproductive goals. Bipolar electrocoagulation during laparoscopic ovarian endometrioma stripping is more detrimental to ovarian reserve than are hemostatic suturing and hemostatic matrix, and should be avoided.