Ovarian suspension for adhesion prevention during laparoscopic excision of severe pelvic endometriosis and endometrioma excision: a systematic review

Ovarian adhesions are fibrous connections, which develop between the ovaries and the surrounding organs as a result of a prior traumatic surgery in this area. Several studies suggest ovarian suspension as a way to prevent them; however, to date, there is no consensus regarding its effectiveness in the field. To investigate whether the application of ovarian suspension would be beneficial in the prevention of postoperative ovarian adhesions. We used Medline (1966–2015), Scopus (2004–2015), ClinicalTrials.gov (2008–2015), Cochrane Central Register of Controlled Trials (CENTRAL; 1999–2015), and Google Scholar (2004–2015) search engines in our primary search, together with reference lists from included studies. Four studies were included in our systematic review, which recruited 105 women of fertile age. The rates of absence of adhesions were between 41 and 80 %. In their majority, adhesions were mild whenever reported, with the exception of the study of Ouahba et al. who found that adhesions of moderate severity had an incidence of 33 %. None of the included studies reported the incidence of preoperative and postoperative symptoms. Current evidence suggests that ovarian suspension could be an effective and feasible surgical technique, which might actually help reduce postoperative adhesions. However, future research is needed in this field, as the number of studies published in this field is relatively small to reach firm conclusions.