Effectiveness and Safety of Postoperative Medical Treatments Following Fertility‐Preserving Surgery for Endometriosis: A Network Meta‐Analysis

BACKGROUND: Endometriosis (EMs) is a common gynaecological condition with high recurrence rates after fertility-preserving laparoscopic surgery, and optimal postoperative medical treatment remains unclear. OBJECTIVES: To evaluate the efficacy and safety of various postoperative medical treatments in reducing recurrence, pain and adverse events in EMs patients after fertility-preserving surgery. SEARCH STRATEGY: PubMed, Web of Science, CENTRAL and Embase databases searched until August 1, 2024. SELECTION CRITERIA: Randomised controlled trials (RCTs) involving women aged 20-45 years post-fertility-preserving laparoscopic surgery, comparing single postoperative medications with a minimum follow-up of 2 months. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed quality using ROB 2.0 and CINeMA. Bayesian network meta-analysis calculated odds ratios (OR) and mean differences (MD) for recurrence rates, VAS pain reduction and adverse events. MAIN RESULTS: Sixteen RCTs (n = 1605 participants) evaluated 10 drugs: danazol, desogestrel, dienogest, gestrinone, goserelin, leuprolide, LNG-IUS, medroxyprogesterone, oral contraceptives and triptorelin. Only LNG-IUS significantly reduced recurrence rates (OR 0.12, 95% CI 0.02-0.63) and showed the greatest reduction in VAS pain scores (MD -24.96, 95% CI -41.76 to -8.75). Danazol significantly increased weight gain, and goserelin increased hot flashes. CONCLUSIONS: LNG-IUS combined with laparoscopic surgery appears most effective in reducing recurrence and pain in EMs patients. Danazol and goserelin should be used cautiously due to notable adverse effects.