الفهرس 
EndometriosisOnly 14 pages are availabe for public view
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Abstract
Endometriomas is defined as the presence of endometrial glands and stroma like lesions outside the uterine cavity including the Ovaries, Douglas pouch, Uterosacral ligaments, vulva, bladder and rectum(6). Oxidized Regenerated Cellulose is a topical absorbable agent that has been introduced in surgical fields as an effective measure for haemostasis especially for oozing surfaces. In addition to the mechanical compression (tamponade –like) at the bleeding sites, it acts as a physical barrier that stimulates platelet aggregation and clotting, and promotes haemostasis by triggering vasoconstriction and by the denaturation of blood proteins and the formation of artificial gel-like clot(4, 5). It is used in treatment of Endometriosis to eliminate or postpone endometriomas’ recurrence and to preserve Ovarian reserve subsequently increasing pregnancy rate(4, 5). So, this prospective randomized controlled study was carried out to evaluate the benefit of Oxidized Regenerated Cellulose in surgical management of ovarian endometriomas to reduce the rate of recurrence while preserving ovarian reserve. Our study was carried out on 60 patients, divided into two groups: group A (drainage and ablation): 30 patients underwent laparoscopic drainage of ovarian endometrioma followed by electrocautery of the endometriomal cyst wall.group B (drainage and Oxidized Regenerated Cellulose): 30 patients underwent laparoscopic drainage of ovarian endometrioma followed by insertion of Oxidized Regenerated Cellulose inside the cyst cavity. Including Women aged from 20 to 35 years, with endometriosis-related clinical manifestations (infertility, pelvic pain or pelvic mass), unilateral and unilocular endometrioma (≥5 cm), good ovarian reserveAMH > 1 ng/mland AFC > 4), and candidate for conservative laparoscopic treatment of ovarian endometriomas. Excluding; Recurrent and bilateral cases, suffers chronic diseases (e.g. cardiac disease or diabetes), or has any contraindication for laparoscopic surgery (excessive anterior abdominal wall scarring). Each participant was subjected to; 1) Full history taking [Personal, obstetrical, gynecological, family, medical and surgical histories]. 2) Complete Physical Examination. 3) Laboratory Investigations [CBC, prothrombin time and activity, liver function, kidney function, serum AMH]. 4) Imaging [Transvaginal ultrasound, AFC]. Our study results have revealed that the mean age of Oxidized Regenerated Cellulose group was (29.33 ± 3.133 years), of the ablation group it was (30.00 ± 2.613 years), without statistically significant difference between the two groups (p= 0.374). BMI of Oxidized Regenerated Cellulose group was (26.39 ± 2.298 kg/m2), of the ablation group it was (27.02 ± 2.016 kg/m2), without statistically significant difference between the two groups (p= 0.268). The most common manifestation in the Oxidized Regenerated Cellulose group was pelvic pain in 43.3% of patient’s vs 23.3% in the ablation group, while the most common manifestation in the ablation group was secondary infertility in 33.3% of patient’s vs 13.3% in the Oxidized Regenerated Cellulose group, without statistically significant difference between the two groups (p= 0.224). The most affected side was the right side in 60% of the Oxidized Regenerated Cellulose group and 53.3% of ablation group, without statistically significant difference between the two groups (p= 0.602).The mean size of endometrioma was (6.58 ± 1.566 cm) in the Oxidized Regenerated Cellulose group, and (6.60 ± 1.552 cm) in the ablation group, without statistically significant difference between the two groups (p= 0.967). There was a statistically significant difference according to 3 and 6 months AMH (ng/ml) being higher in ORC group compared to ablation group as the reduction in AMH (change) was significantly lower in ORC group (P values<0.001). Basal AMH was insignificantly different between both groups. Regarding AMH follow up values after three and six months, they were insignificantly different than basal AMH in ORC group. Regarding Ablation group, AMH follow up values after three and six months were significantly lower compared to basal AMH as P values <0.001. There was a statistically significant difference according to Antral Follicular Count after 3 and 6 months of laparoscopy being higher in ORC group compared to ablation group as the AFC reduction (change) was significantly lower in ORC group (P values< 0.001). Regarding AFC follow up values after 3 and 6 months, they were insignificantly different than basal AFC in ORC group. In terms of Ablation group, AFC follow up values after 3 and 6 months were significantly lower compared to basal AFC as P values<0.001. The recurrence rate of ovarian endometrioma was comparable between both groups. In terms of AMH, it was significantly associated with the recurrence of ovarian endometrioma 3 and 6 months after laparoscopy being lower in patients who suffered from recurrence than those who didn’t as P value= 0.023, 0.022 respectively while there was no relation between the recurrence and AMH at the start of the study