Comparison of ovarian reserve after cystectomy of ovarian endometrioma by bipolar coagulation, suture method, or hemostatic sealants: An updated meta‐analysis

Abstract Aim The purpose of the study was to compare the ovarian reserve after cystectomy of ovarian endometrioma by bipolar coagulation, suture method, or hemostatic sealants (HSs). Methods We performed a meta‐analysis of studies in which post‐cystectomy serum anti‐Müllerian hormone (AMH) values were compared between bipolar coagulation and suture method or between bipolar coagulation and HSs. Through a literature search, we retrieved 14 articles which met inclusion criteria and were eligible for final analysis. The articles included 10 randomized trials, 3 prospective studies, and 1 retrospective study ( n = 1435). The primary outcome was post‐cystectomy serum AMH values. Results Both bipolar coagulation and suture methods showed significantly lower post‐cystectomy AMH values at 3, 6, and 12 months. However, post‐cystectomy serum AMH values at 12 months were significantly higher in the suture method group compared to the bipolar coagulation (weighted mean difference [WMD]: −1.10, 95% confidence interval [CI]: −1.83, −0.38, p = 0.003, I 2 = 89, n = 3). The suture method also showed a lower decline rate at 3 months post‐cystectomy compared to the bipolar coagulation group (WMD: −25.13%, 95% CI: −49.56 to −0.70, p = 0.04, I 2 = 95%, n = 2). Overall, pregnancy rates were similar between the two groups. Between the bipolar coagulation and HSs group, serum AMH values at 3 months post‐cystectomy were similar (WMD: −0.46, 95% CI: −1.04 to 0.13, p = 0.13, I 2 = 0%, n = 3). However, the HSs group showed a less decline rate at 3 months post‐cystectomy compared to the bipolar coagulation group (WMD: −17.02%, 95% CI: −22.81, −11.23, p < 0.00001, I 2 = 0%, n = 3). Conclusions Both the suture method and HSs may have potential benefits in the preservation of ovarian reserve over the bipolar coagulation method when cystectomy for ovarian endometrioma is performed.