Long-term effects of bipolar electrocoagulation and suture hemostasis on the ovarian reserve following endometriotic cystectomy: a meta-analysis.

Objective: The long-term impact of electrocoagulation and suture hemostasis on ovarian reserve (OR) after endometriotic cystectomy remains uncertain. This meta-analysis aimed to compare the short-term and long-term effects of coagulation and suture hemostasis on ovarian reserve based on the postoperative levels of the anti-Müllerian hormone (AMH).

Methods: PubMed, MEDLINE, EMBASE, Cochrane, and other databases were searched for eligible studies published up to May 2023.The quality assessment of the RCTs was performed as indicated by the Cochrane Collaboration tool in the Cochrane Handbook. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the non-RCTs. The random-effects or fixed-effects model was used to quantify the weighted mean difference (WMD) at the 95% confidence interval (CI) in the treatment effect across the different studies.

Results: Six randomized controlled trials and two prospective studies were included in this meta-analysis. The meta-analysis showed that there was a statistically significant difference in the AMH levels between the electrocoagulation and the suture group at 1 month (WMD: -0.52, 95%CI (-1.02, -0.01), P = 0.04), 3 months (WMD: -0.72, 95%CI (-1.13, -0.31), P = 0.0005), 6 months (WMD: -0.80, 95%CI (-1.22, -0.38), P = 0.0002) and 12 months (WMD: -0.81, 95%CI (-1.24, -0.37), P = 0.0003), postoperatively. The mean difference of AMH in electrocoagulation group at 1, 3, 6 and 12 months after surgery was -1.75; -1.37; -1.10; -0.92 respectively; meanwhile, in the suture group were -2.50; -2.46; -2.33; -2.24, respectively.

Conclusion: Compared with electrocoagulation, suture hemostasis has less impact on OR. Although the OR of two groups gradually recovered, electrocoagulation still caused more damage to AMH than suture at 12 months after surgery. Suturing could be a better choice after stripping ovarian endometriomas.