Liselotte W Maassen, Daniëlle M van Gastel, Mirthe A J M van Erp, Kirsten Bos, Carolien A M Koks, Marlies Y Bongers, Sebastiaan Veersema
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引用次数: 0
Abstract
Objective: To evaluate clinical outcomes of Essure removal surgery, focusing primarily on symptom reduction and secondarily on indications for removal, quality of life (QoL), surgical technique, and complications.
Data sources: PubMed, EMBASE and the Cochrane library were searched.
Methods of study selection: Studies reporting outcomes of Essure removal were eligible; case reports and articles not in English or Dutch were excluded. Screening of 401 records identified 18 studies between 2014 and 2024, involving 2,034 women in case series, prospective or retrospective cohorts, and one multicentre prospective study. No randomized controlled trials on this topic exist. Methodological quality was assessed using the JBI Critical appraisal checklist for case series: 16 studies were low, 1 moderate, and 1 high risk of bias.
Tabulation, integration and results: Significant symptom improvement, including pain reduction, reduction in abnormal uterine bleeding, and asthenia, was reported in 7 studies. Persisting or worse symptoms were reported. Significant QoL improvements were observed in 5 studies. The most frequent procedure was laparoscopic bilateral salpingectomy with device (52.3%), followed by laparoscopic removal and bilateral salpingectomy with cornua resection (17.5%) and hysterectomy (25.2%), of which 73.4% laparoscopic. The overall complication rate was 6.5% (1.2% intraoperative, 5.3% postoperative).
Conclusion: Essure removal surgery is generally safe and the majority of patients report reduced pain, improved symptoms and enhanced QoL. However, persistent or worsening symptoms occur. Evidence quality is limited due to retrospective case series and cohort designs, absence of control groups, and heterogeneous, non-standardized symptom and QoL measures.
Source of funding: none REGISTRATION OF SYSTEMATIC REVIEWS: The protocol of this review was prospectively registered on PROSPERO, registration ID: CRD42021225083. The protocol can be accessed via https://www.crd.york.ac.uk/PROSPERO/view/CRD42021225083.
期刊介绍：
The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.
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