Impact of surgery for endometriosis on the outcomes of in vitro fertilization.

This narrative review aims to summarize available evidence on the IVF-associated outcomes after surgery for endometriosis. Only one retrospective study investigated if surgical treatment of superficial/peritoneal endometriosis may modify the outcomes of IVF; therefore, more data are needed to confirm the benefit of surgery for this type of disease for improving ART outcomes, and to be able to support it in routine practice. Solid evidence from several meta-analyses demonstrates that surgical treatment of endometriomas does not enhance the outcomes of IVF. In contrast, surgical treatment of ovarian endometriosis may lead to a reduction in ovarian reserve, especially in cases involving bilateral endometriomas or repeated surgical procedures. Some non-randomized studies have examined if surgical treatment on deep endometriosis may influence IVF outcomes. A systematic review with meta-analysis revealed that patients who underwent surgery before IVF exhibited significantly higher pregnancy rates per patient, pregnancy rates per cycle, and live birth rates per patient compared to those without prior surgery. However, the available data are insufficient to recommend surgical excision of deep endometriosis as the first-line treatment for asymptomatic patients to enhance IVF outcomes.

Bowel preparation before laparoscopic gynaecological surgery in benign conditions using a 1-week low fibre diet: a surgeon blind, randomized and controlled trial.

PURPOSE: The aim of this randomized, surgeon-blind, controlled study was to evaluate the role of a 7 days minimal-residue (low fibre intake) pre-operative diet compared with a mechanical bowel preparation in laparoscopic benign gynaecological surgery. METHODS: This was a randomized, surgeon-blind, controlled study. The study included 83 women scheduled to undergo diagnostic or operative laparoscopy for various gynaecological benign conditions. Exclusion criteria were suspicion of malignancy, associated non-gynaecological surgical pathologies, severe endometriosis, and history of previous abdominal surgery. Study group had a total daily fibre intake inferior to 10 g for a week before the operation (n = 42). Control group had a mechanical bowel preparation the day before the operation (n = 41). The principal measures of outcome were the quality of bowel preparation, the acceptability of the preoperative diet and of the mechanical bowel preparation. Secondary outcomes included postoperative pain, time of ambulation, length of postoperative ileus, and length of postoperative hospital stay. RESULTS: The two treatment groups were comparable with respect to demographic characteristics and indications for surgery. Preoperatively, abdominal distension and overall discomfort were significantly more frequent in the control group (P = 0.061 and 0.034 respectively). There was no significant difference in the small and large bowel preparation between the two groups. Postoperatively, no significant difference was observed between the two groups in pain, nausea, abdominal swelling, length of ileus, and of postoperative stay. CONCLUSIONS: This study shows that preoperative low fibre diet and mechanical bowel preparation provide similar quality of surgical field exposure. However, when compared with mechanical bowel preparation, preoperative low fibre diet may be better tolerated by the patients, thus increasing compliance. Moreover, a 7 days preoperative low fibre diet allow the patient to continue working and social activities until the day of surgery without requiring admission to the hospital or home bowel preparation on the day before surgery.

Topical diclofenac patch for postoperative wound pain in laparoscopic gynecologic surgery: a randomized study.

STUDY OBJECTIVE: To compare pain management of standard analgesic and standard analgesic plus diclofenac transdermal patch in patients who undergo laparoscopic gynecologic surgery. DESIGN: Randomized prospective study (Canadian Task Force classification I). SETTING: University hospital. PATIENTS: One hundred twenty patients requiring laparoscopic surgery for gynecologic benign diseases. INTERVENTIONS: Patients were divided into two groups, one medicated with a diclofenac patch (diclofenac group) and the other medicated with standard skin medication (placebo; control group) at all incisional areas at the end of the operation. MEASUREMENTS AND MAIN RESULTS: The principal measures of outcome were pain intensity at 6, 12, and 24 hours after surgery and consumption of analgesics. The two treatment groups were comparable with respect to demographic and intraoperative characteristics. No significant difference was observed between the two groups in mean pain intensity at 6 hours after surgery. Mean pain intensity at 12 and 24 hours, respectively, after surgery was significantly lower in the diclofenac group (3.7 +/- 1.3 and 2.0 +/- 0.6) than that observed in the control group (5.7 +/- 1.9 and 4.6 +/- 0.5) (p value, respectively, .002 and <.001). Twenty-one patients (35.0%) in the diclofenac group required analgesics in the first 36 hours after the operation versus 43 patients (71.7%) in the control group (p <.001). Hospital discharge was significantly more rapid in the diclofenac group (28 +/- 5 hours vs 39 +/- 3 hours; p = .031). CONCLUSION: Diclofenac transdermal administration seems a valid help to standard analgesic treatment in postoperative pain control and could also help reduce the period of hospitalization of patients who undergo laparoscopic benign gynecologic surgery.