Chapter 75: PEARS for Polycystic Ovaries: Ovarian Wedge Resection

This chapter describes ovarian wedge resection for polycystic ovarian disease (PCOD), reviewing its history and the later observation that adhesions after the older technique were felt to aggravate infertility. The chapter lists the indications as a definitive diagnosis of polycystic ovaries made from ultrasound findings, direct laparoscopic viewing of the ovaries, hyperandrogenemia and reversal of the FSH:LH ratio. The technique uses a small Pfannenstiel incision, a CO2 laser wedge incision, a 2-0 Chromic suture buried in the ovarian stroma and a running 5-0 Prolene closure of the cortex that inverts the cut edges, followed by an Interceed barrier. The chapter reports that ovaries re-examined at later laparoscopy, including two photographed nine years after surgery, were almost universally adhesion free, and it concludes that after wedge resection the menstrual cycles resume their cyclicity and androgen levels decrease significantly.