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Effectiveness of ovarian suspension in preventing post-operative ovarian adhesions in women with pelvic endometriosis: a randomised controlled trial.

Hoo WL, Saridogan E, Cutner A, Pandis G, Jurkovic D - BMC Womens Health (2011)

Bottom Line: Both ovaries are routinely suspended to the anterior abdominal wall during surgery.The primary outcome is the prevalence of ovarian adhesions on ultrasound examination.Secondary outcomes are the presence, intensity and site of post-operative pain.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Obstetrics and Gynaecology, University College Hospital, London, NW1 2BU, UK. willhoo@hotmail.com

ABSTRACT

Background: Endometriosis is a common benign condition, which is characterized by the growth of endometrial-like tissue in ectopic sites outside the uterus. Laparoscopic excision of the disease is frequently carried out for the treatment of severe endometriosis. Pelvic adhesions often develop following surgery and they can compromise the success of treatment. Ovarian suspension (elevating both ovaries to the anterior abdominal wall using a Prolene suture) is a simple procedure which has been used to facilitate ovarian retraction during surgery for severe pelvic endometriosis. The study aims to assess the effect of temporary ovarian suspension following laparoscopic surgery for severe pelvic endometriosis on the prevalence of post-operative ovarian adhesions.

Methods: A prospective double blind randomised controlled trial for patients with severe pelvic endometriosis requiring extensive laparoscopic dissection with preservation of the uterus and ovaries. Severity of the disease and eligibility for inclusion will be confirmed at surgery. Patients unable to provide written consent, inability to tolerate a transvaginal ultrasound scan, unsuccessful surgeries or suffer complications leading to oophorectomies, bowel injuries or open surgery will be excluded. Both ovaries are routinely suspended to the anterior abdominal wall during surgery. At the end of the operation, each participant will be randomised to having only one ovary suspended post-operatively. A new transabdominal suture will be reinserted to act as a placebo. Both sutures will be cut 36 to 48 hours after surgery before the woman is discharged home. Three months after surgery, all randomised patients will have a transvaginal ultrasound scan to assess for ovarian mobility. Both the patients and the person performing the scan will be blinded to the randomisation process. The primary outcome is the prevalence of ovarian adhesions on ultrasound examination. Secondary outcomes are the presence, intensity and site of post-operative pain.

Discussion: This controlled trial will provide evidence as to whether temporary ovarian suspension should be included into the routine surgical treatment of women with severe pelvic endometriosis.

Trial registration: ISRCTN: ISRCTN24242218.

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Related in: MedlinePlus

Flowchart of ovarian suspension study.
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Figure 1: Flowchart of ovarian suspension study.

Mentions: Three months after ovarian suspension, all patients in the study will be invited for a transvaginal ultrasound scan to assess ovarian mobility (Figure 1). Ovarian adhesions will be diagnosed in women with evidence of restricted ovarian mobility on targeted palpation using transvaginal ultrasound probe [14]. The ultrasound operators will be blinded to the details of the operative procedure and women's randomisation allocation.


Effectiveness of ovarian suspension in preventing post-operative ovarian adhesions in women with pelvic endometriosis: a randomised controlled trial.

Hoo WL, Saridogan E, Cutner A, Pandis G, Jurkovic D - BMC Womens Health (2011)

Flowchart of ovarian suspension study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3119028&req=5

Figure 1: Flowchart of ovarian suspension study.
Mentions: Three months after ovarian suspension, all patients in the study will be invited for a transvaginal ultrasound scan to assess ovarian mobility (Figure 1). Ovarian adhesions will be diagnosed in women with evidence of restricted ovarian mobility on targeted palpation using transvaginal ultrasound probe [14]. The ultrasound operators will be blinded to the details of the operative procedure and women's randomisation allocation.

Bottom Line: Both ovaries are routinely suspended to the anterior abdominal wall during surgery.The primary outcome is the prevalence of ovarian adhesions on ultrasound examination.Secondary outcomes are the presence, intensity and site of post-operative pain.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Obstetrics and Gynaecology, University College Hospital, London, NW1 2BU, UK. willhoo@hotmail.com

ABSTRACT

Background: Endometriosis is a common benign condition, which is characterized by the growth of endometrial-like tissue in ectopic sites outside the uterus. Laparoscopic excision of the disease is frequently carried out for the treatment of severe endometriosis. Pelvic adhesions often develop following surgery and they can compromise the success of treatment. Ovarian suspension (elevating both ovaries to the anterior abdominal wall using a Prolene suture) is a simple procedure which has been used to facilitate ovarian retraction during surgery for severe pelvic endometriosis. The study aims to assess the effect of temporary ovarian suspension following laparoscopic surgery for severe pelvic endometriosis on the prevalence of post-operative ovarian adhesions.

Methods: A prospective double blind randomised controlled trial for patients with severe pelvic endometriosis requiring extensive laparoscopic dissection with preservation of the uterus and ovaries. Severity of the disease and eligibility for inclusion will be confirmed at surgery. Patients unable to provide written consent, inability to tolerate a transvaginal ultrasound scan, unsuccessful surgeries or suffer complications leading to oophorectomies, bowel injuries or open surgery will be excluded. Both ovaries are routinely suspended to the anterior abdominal wall during surgery. At the end of the operation, each participant will be randomised to having only one ovary suspended post-operatively. A new transabdominal suture will be reinserted to act as a placebo. Both sutures will be cut 36 to 48 hours after surgery before the woman is discharged home. Three months after surgery, all randomised patients will have a transvaginal ultrasound scan to assess for ovarian mobility. Both the patients and the person performing the scan will be blinded to the randomisation process. The primary outcome is the prevalence of ovarian adhesions on ultrasound examination. Secondary outcomes are the presence, intensity and site of post-operative pain.

Discussion: This controlled trial will provide evidence as to whether temporary ovarian suspension should be included into the routine surgical treatment of women with severe pelvic endometriosis.

Trial registration: ISRCTN: ISRCTN24242218.

Show MeSH
Related in: MedlinePlus