The effect of second‐line surgery on reproductive performance of women with recurrent endometriosis: A systematic review

Paolo Vercellini, Edgardo Somigliana, Paola Viganò, Sara De Matteis, Giussy Barbara, Giussy Barbàra, Luigi Fedele
Acta obstetricia et gynecologica Scandinavica · 2009 · vol. 88(10) , pp. 1074–1082 · doi:10.1080/00016340903214973 · PMID:19707899 · W1964274134
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This systematic review found that second-line surgery for recurrent endometriosis resulted in lower pregnancy rates compared to primary surgery, while in-vitro fertilization outcomes were not inferior to reoperation.

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Abstract

Estimates of endometriosis recurrence after primary surgery are around 10% per annum during the first postoperative quinquennium. The aim of this study was to define the effect of reoperation in women seeking conception. A MEDLINE and PubMed search was conducted to identify English language studies published in the last 30 years evaluating reproductive performance after second-line surgery. Repeat surgery for recurrent endometriosis and identification of women seeking pregnancy were selected. Two authors abstracted data on standardized forms. The initial literature screening yielded 41 citations, but 19 were excluded because no data on reoperation were described, seven as no original figures were included, three because analyses were performed on the same cohort, and one because extremely skewed data were reported. A total of 313 patients who sought pregnancy after repetitive surgery for recurrent endometriosis were found, 139 in six non-comparative studies, and 174 in five retrospective comparative studies. Overall, pregnancy was achieved in 81 women (26%; 95% confidence interval (CI), 21-31%), without significant difference between the laparotomy (27%) and laparoscopy (25%) approach. Three studies compared pregnancy rate after second-line (28/124; 23%) and primary surgery (236/577; 41%; common odds ratio (OR), 0.44; 95% CI, 0.28-0.68%), and two compared the probability of conception after in-vitro fertilization (IVF) (14/27; 30%) and repetitive surgery (10/50; 20%; common OR, 1.51; 95% CI, 0.58-3.91%). Conclusions. The probability of conception after repeat surgery for recurrent endometriosis appeared limited and reduced compared with that after primary surgery. The results of IVF were not inferior to those of reoperation.

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Endometriosis Pregnancy Outcome Adult Endometriosis Female Fertilization in Vitro Humans Pregnancy Pregnancy Rate Recurrence Reoperation Reproductive Techniques, Assisted

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (58)

Cited by (50)

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