Safety of Hemostatic Sutures for Hemostasis of the Ovarian Bed After Endometriotic Ovarian Cystectomy

Abstract

The use of the hemostatic sutures minimizes the damage related to the use of cautery in the ovarian bed after cystectomy. The main concern for the wide use of this method is the concerns about the safety of the sutures as the hemostasis seems to be incomplete when compared to cauterization. To study the safety of hemostatic sutures for achieving hemostasis of the ovarian bed after ovarian cystectomy of endometrioma. Prospective cohort controlled study. Shatby maternity University hospital. Eighty-four women with endometrioma were included in the study. Patients were randomized to laparoscopic ovarian cystectomy with use of electrocautery (bipolar or unipolar) or use of sutures for control of bleeding from the ovarian bed. All cases underwent laparoscopy for removal of ovarian endometriomas by stripping. Hemostasis of the bleeding from the ovarian bed was controlled by either electrocautery (bipolar or monopolar) or hemostatic sutures. Effect of the use of both methods was studied including hemoglobin level, hematocrit level, duration of surgery, number of sutures needed, duration of hospital stay, need for blood transfusion and postoperative complications including ovarian hematomas. There was a routine use of intraperitoneal drain in all suture cases. It was found that using hemostatic suture was effective in controlling the bleeding from the ovarian bed. The hemoglobin and the hematocrit were comparable in both groups. Complications for both techniques were documented and treated. It could be concluded that hemostatic sutures are safe procedure and tolerable for the patient although more cases with complication in the suture group which was not statistically significant and there was longer hospital stay. This technique has the advantage of minimizing the damage of cystectomy to stripping only by avoiding cauterization of healthy ovarian tissues.