The application of Surgicel, a material used to help control bleeding, can reduce the chance of recurrence following surgery for ovarian endometriomas, a new study suggests.
The study, titled “A randomized controlled trial of a new technique for laparoscopic management of ovarian endometriosis preventing recurrence and keeping ovarian reserve,” was published in the Journal of Ovarian Research.
Ovarian endometriomas are cyst-like structures (bags of fluid) that are detected in 17%–44% of people with endometriosis. These are typically dealt with surgically, either by drainage (removing the fluid) and ablation of the cyst wall or a cystectomy (removing the whole structure), but the procedures may reduce a person’s reproductive potential. As many as a third of those who undergo such procedures also experience a recurrence later in life.
Researchers investigated whether using Surgicel during these procedures might reduce recurrence and/or improve ovarian health and reserve. Surgicel is an oxidized regenerated cellulose agent that looks like gauze, and can promote blood clotting and reduce bleeding. Importantly, it is less expensive and causes less damage than other methods to reduce bleeding in surgery, i.e. cauterizing using electricity.
For the study, two hundred people, from 20–35 years old, with ovarian endometriomas were recruited and randomized to undergo drainage or a cystectomy, with or without the placement of four to eight pieces of Surgicel, as needed, in a drained cyst or remaining ovarian tissue. The 50 patients in each of the four groups were followed up for two years. All groups were similar in terms of age, demographics, and clinical presentation.
Among patients who were treated with drainage and Surgicel, the recurrence rate after two years was 10.9%, a result significantly lower than the rate of 27.1% in patients who received drainage alone. Similarly, there was a significantly lower recurrence rate among those who received a cystectomy plus Surgicel (9.1%) compared with those who received a cystectomy without Surgicel (24.4%).
Over the two-year study period, 17 women became pregnant, including 10 who were treated with Surgicel and seven who weren’t. This difference was not statistically significant, so no conclusions could be made about Surgicel’s effect on reproductive health. However, this was a relatively short-term study, so further research will be needed to fully assess how Surgicel use impacts reproductive capabilities, the researchers said.
Anti-Mullerian hormone levels and antral follicle count, two measurements of ovarian health, were also assessed. Surgicel was significantly beneficial for patients who underwent drainage, but did not seem to have an effect on individuals who got a cystectomy. In all groups, the values ranged widely for individual patients, so more research will be needed to thoroughly assess the use of Surgicel on ovarian health.
Surgicel was also found to be generally safe, with no complications or side effects recorded.
“The present study has demonstrated that Surgicel reduces effectively the recurrence risk of endometriomas following either laparoscopic cystectomy or drainage,” the researchers said.