Ovarian wedge resection by minilaparatomy in infertile patients with polycystic ovarian syndrome: a new technique

Mulazim Yildirim; Volkan Noyan; M Bulent Tiras; Akgun Yildiz; Haldun Guner

doi:10.1016/s0301-2115(02)00348-2

Reproductive Surgery Ovarian Surgery

Ovarian wedge resection by minilaparatomy in infertile patients with polycystic ovarian syndrome: a new technique

Yildirim M, Noyan V, Bulent Tiras M, Yildiz A, Guner H

Published March 26, 2003 European Journal of Obstetrics, Gynecology, and Reproductive Biology, 107(1), 85-87

DOI 10.1016/s0301-2115(02)00348-2 PMID 12593902

RRM Academy Synopsis

Pregnancy followed wedge resection in 90% of 134 women with PCOS

Within 2 years of ovarian wedge resection, 121 of 134 infertile women got pregnant. This was a retrospective case series of women with PCOS, also called PMOS (Polyendocrine Metabolic Ovarian Syndrome). Of 44 women assessed at cesarean delivery or diagnostic laparoscopy, 5 had filmy adhesions.

Key Findings

Pregnancies occurred in 121 of 134 women (90%) within 2 years of the operation; 104 women (78%) conceived within 6 months and 17 more (13%) between 6 and 24 months.
Sixty-eight women (51%) had a second pregnancy later.
Adhesions were assessed in 44 women: 24 at cesarean delivery and 20 at diagnostic laparoscopy after no conception in the first 12 months. Five of the 44 (11%) had filmy adhesions.
None of the 44 women examined had dense adhesions. Hospital stay after the operation was 1 day.

Interpretation

The report is a retrospective case series of women treated in Ankara, Turkey between January 1992 and November 1999. All 134 women had PCOS with no ovulation, and repeat testing found no other cause of infertility. The surgeon removed about half of each ovary through a 3 to 4 cm incision. Adhesions were assessed at cesarean delivery or diagnostic laparoscopy in 44 women. The authors note that without a control group they could not demonstrate statistically significant conclusions.

RRM Context

Restorative reproductive medicine treats the cause of infertility. This operation removes part of the ovary that makes male hormones, so ovulation can resume. The authors compare their 11% adhesion rate with 19 to 86% reported after heat treatment of the ovary surface.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To determine the effects of ovarian wedge resection by minilaparotomy in infertile patients with polycystic ovarian syndrome (PCOS).

Study Design

One hundred and thirty-four anovulatory patients with PCOS, who were previously treated with clomiphene citrate and gonadotropins and did not conceive were operated via minilaparotomy with microsurgical principles and ovarian wedge resection was performed on each subject. Pregnancy rates and adhesion formation were investigated retrospectively.

Results

A total of 121 pregnancies were achieved in 2 years (90%). One hundred and four patients conceived within the first 6 months (78%) and the remaining 17 patients conceived within 2 years (13%) following the operation. Sixty-eight patients had a second pregnancy later. In the post-operative period, 24 patients had cesarean delivery and 20 had diagnostic laparoscopy. Out of these 44 patients, only 5 of them were found to have minimal adhesions.

Conclusion

This technique offers high pregnancy rates and minimal adhesion formation. Ovarian wedge resection by minilaparotomy might be an alternative treatment approach in patients with PCOS who did not conceive with standard ovulation induction protocols.

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Topics

Reproductive Surgery › Ovarian Surgery › Cystectomy Technique · PMOS / PCOS › Surgical Treatment › Ovarian Wedge Resection

Mulazim Yildirim, Volkan Noyan, M Bulent Tiras, Akgun Yildiz, Haldun Guner

M Yildirim, V Noyan, A Yildiz, H Guner

PMID 12593902 12593902 DOI 10.1016/s0301-2115(02)00348-2 10.1016/s0301-2115(02)00348-2 Yildirim et al. 2003, Yildirim 2003

Keywords

Adult, Cesarean Section, Female, Humans, Infertility, Female/etiology/surgery, Laparotomy/methods, Ovary/surgery, Polycystic Ovary Syndrome/complications, Pregnancy, Tissue Adhesions/epidemiology, Treatment Outcome

Ovarian wedge resection by minilaparatomy in infertile patients with polycystic ovarian syndrome: a new technique

Pregnancy followed wedge resection in 90% of 134 women with PCOS

Key Findings

Interpretation

RRM Context

Abstract

Read the guides

Fertility-Preserving Surgery: Restorative, Specialist, and Conventional Approaches Compared

PMOS / PCOS: Causes, Diagnosis, and Treatment

Topics

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