Effectiveness and Safety of Postoperative Medical Treatments Following Fertility-Preserving Surgery for
Yi Xiong1, Wenrui Huang2, Chenxin Wang2
1Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China.
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.
