The role of ovarian suspension in preventing post-surgical ovarian adhesions in patients with stage III-IV pelvic endometriosis: a systematic review

Endometriosis is a benign complex gynecological condition with high morbidity that affects women of reproductive age. Pelvic adhesion formation represents a serious clinical challenge in the management of patients with endometriosis. Several interventions have been proposed over the last few years aiming to reduce post-operative ovarian adhesions formation. The aim of this study is to summarize the evidence of the efficacy of ovarian suspension in the prevention of post-operative ovarian adhesions formation in women undergoing laparoscopic surgery for stage III-IV endometriosis. The research was conducted using electronic databases. A review of the abstracts of all references retrieved from the search was conducted. Selection criteria for the systematic review included all randomized controlled trials (RCTs) and non-randomized studies (NRSs) of premenopausal women diagnosed with stage III-IV pelvic endometriosis who underwent ovarian suspension or no ovarian suspension (control group). RCTs were eligible for meta-analysis. Eight studies were included in the systematic review: 2 RCTs and 6 NRSs. In all studies, ovarian suspension was performed during surgery for stage III-IV endometriosis. The site of the suspension was the anterior abdominal wall in 76.8% of the cases. Five studies reported the use of Polypropylene (Prolene® Ethicon Inc., Somerville, NJ, USA) as suture for the suspension. Removal of the suspension suture in the post-operative period was reported in six studies. Pooled data based on meta-analysis of RCTs showed that women who underwent ovarian suspension had a significantly lower incidence of postoperative adhesions formation in particular of moderate-severe adhesions. Ovarian suspension may reduce the rate and severity of postoperative adhesions formation in women undergoing laparoscopy for the treatment of stage III-IV endometriosis, but RCTs with larger samples size are needed.