Laparoscopic Surgery versus Laparotomy for Women with Polycystic Ovarian Syndrome: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

ZENG Qingyuan ¹ ,  XU Liangzhi ² , ZHANG Nannan ³

1. Departments of Obstetrics & Gynecology, Chengdu Military General Hospital, Chengdu 610083, China; 2. Departments of Reproductive Endocrinology & Family Planning, West China Second University Hospital, Chengdu 610041, China; 3. Departments of Medical Administration, Chengdu Military General Hospital, Chengdu 610083, China;

Corresponding author：

XU Liangzhi, Email: liangzxu@126.com

Keywords：

Polycystic ovarian syndrome; Laparoscopic surgery; Laparotomy; Non-randomized trial; Systematic review

DOI：

10.7507/1672-2531.20100607

Video：

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Objective 　To compare the efficacy and incidence of complications between laparoscopic surgery and laparotomy on women with polycystic ovarian syndrome (PCOS).
Methods 　We did a systematic literature search for studies from Ovid Database, MEDLINE, EMbase, Cochrane Library (Issue 2, 2008), Chinese Biological Medicine Database, CNKI, Chinese VIP Database, and WANFANG Database on internet. The search time was from establishment of each database to December, 2008. Randomized controlled trials and non-randomized controlled trials were collected. The search was no limitation in language. We manually searched current and conference abstracts, and searched relevant reviews and their reference. RevMan 5.0 software was used for meta-analysis.
Results 　Five non-randomized trials involving 417 patients were included. The results of meta-analyse showed that the short-term pregnancy rate in patients underwent laparoscopic surgery was significantly higher than that in patients underwent laparotomy (RR=1.42, 95% CI 1.13 to 1.80, P=0.003). The long-term pregnancy rate in patients underwent laparoscopic surgery and laparotomy was comparable (RR=0.85, 95%CI 0.68 to 1.07, P=0.17). The regular menstruation in patients underwent laparoscopic surgery and laparotomy was comparable (RR=0.91, 95%CI 0.79 to 1.05, P=0.18). The uterine adhesions in patients underwent laparoscopic surgery was significantly lower than that in patients underwent laparotomy (RR=0.02, 95%CI 0.00 to 0.18, P=0.000 2). The intra-abdominal adhesions of patients underwent laparoscopic surgery was significantly lower than that in patients underwent laparotomy (RR=0.02, 95%CI 0.00 to 0.13, P lt;0.000 1).
Conclusions 　The limited evidence at present shows that the incidence and degree of pelvic adhesions occurred in patients with PCOS after laparoscopic surgery is much lower than those after laparotomy. It is not quite sure at this point about whether the pregnancy rate and regular menstruation of laparoscopic surgery are better than those of lararotomy or not. More evidence from high qualified multi-center studies is needed.

Citation： ZENG Qingyuan,XU Liangzhi,ZHANG Nannan. Laparoscopic Surgery versus Laparotomy for Women with Polycystic Ovarian Syndrome: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(12): 1425-1431. doi: 10.7507/1672-2531.20100607 Copy

1.	Franks S. Polycystic ovary syndrome. N Engl J Med, 1995, 333: 853-861.
2.	许良智, 张静. 多囊卵巢综合征. 现代临床医学, 2006, 32(4): 311-314.
3.	Campo S. Ovulatory cycles, pregnancy outcome and complications after surgical treatment of polycystic ovary syndrome. Obstet Gynecol Surv, 1998, 53(5): 297-308.
4.	Guzick DS. Ovulation induction management of PCOS. Clin obstet gynecol, 2007, 50(1): 255-267.
5.	Imani B, Eijkemans MJC, te Velde ER, et al. Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol and Metab, 1998, 83(7): 2361-2365.
6.	Lobo RA, Gysler M, March CM, et al. Clinical and laboratory predictors of clomiphene response. Fertil Steril, 1982, 37: 168-174.
7.	Hughes E, Collins J, Vandekerckhove P, et al. Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea. Cochrane Database Syst Rev, 2000 (2) (CD000056).
8.	Pritts EA. Treatment of the infertile patient with polycystic ovarian syndrome. Obstet Gynecol Surv, 2002, 57(9): 587–597.
9.	Norman RJ, Dewailly D, Legro RS, et al. Polycystic ovary syndrome. Lancet, 2007, 370(9588): 685-697.
10.	Stein IF, Cohen MR. Surgical treatment of bilateral polycystic ovaries. Am J Obstet Gynecol, 1939, 38: 465-473.
11.	Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil Steril, 1984, 49: 956-960.
12.	Api M, Gorgen H, Certin A. Laparoscopic ovarin drilling in polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol, 2005, 119(1): 76-81.
13.	The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod, 2004, 19(1): 41-47.
14.	Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7( 27): iii-x, 1-173.
15.	Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. J Epidemiol Community Health, 1998, 52(6): 377-384.
16.	Alieva EA, Pshenichnikova Tla, Gasparov AS. Results of laparoscopy in patients with polycystic ovary syndrome after surgical treatment, akush ginekol, 1990, 7: 63-66.
17.	Kentaro T, Nobuyuki K, Fuminori K, et al. A comparative study using early second-look laparoscopic evaluation of postoperative adhesion formation between two surgical procedures for polycystic ovarian syndrome. Obstet Gynecol Surv, 2007, 62(7): 443-445.
18.	冯淑英, 邝健全, 翁梅英, 等. 两种手术方式治疗多囊卵巢综合征的远期疗效追踪比较. 中山大学学报(医学科学版), 2004, 25(3): 260-263.
19.	童莉, 卢海明, 朱进梅, 等. 多囊卵巢综合征所致不孕症腹腔镜手术与开腹手术的对比研究. 实用医学杂志, 2005, 21(20): 2321-2322.
20.	于红, 任慕兰. 两种手术方式治疗多囊卵巢综合征. 东南大学学报, 2004, 23(6): 417-418.
21.	Buttram VC Jr, Vaquero C. Post-ovarian wedge resection adhesive disease. Fertil Steril, 1975, 26(9): 874-876.
22.	Amer S A, Gopalan V, Li T C, et al. Long term follow-up of patiens with polycystic ovarian syndrome after laparoscopic ovarian drilling: clinical outcome. Hum Reprod, 2002, 17(8): 2035-2042.
23.	The American Fertility society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril, 1988, 49(6): 944-955.
24.	Creenblatt EM, Casper RF. Adhesion formation after laparoscopic ovarian cautery for polycystic ovarian syndrome: lack of correlation with pregnancy rate. Fertil Steril, 1993, 60(2): 766-770.
25.	张梅莹, 狄文. 手术治疗多囊卵巢综合征的评估. 中国妇幼健康研究, 2007, 18(1): 51-54.
26.	Dabirashrafi H. Complication of laparoscopic ovarian cauterization. Fertil Steril, 1989, 52: 878-880.
27.	Mike Clark. 非随机对照试验和诊断性试验准确度系统评价的新挑战. 中国循证医学杂志, 2006, 6(4): 240-242.

1. Franks S. Polycystic ovary syndrome. N Engl J Med, 1995, 333: 853-861.
2. 许良智, 张静. 多囊卵巢综合征. 现代临床医学, 2006, 32(4): 311-314.
3. Campo S. Ovulatory cycles, pregnancy outcome and complications after surgical treatment of polycystic ovary syndrome. Obstet Gynecol Surv, 1998, 53(5): 297-308.
4. Guzick DS. Ovulation induction management of PCOS. Clin obstet gynecol, 2007, 50(1): 255-267.
5. Imani B, Eijkemans MJC, te Velde ER, et al. Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol and Metab, 1998, 83(7): 2361-2365.
6. Lobo RA, Gysler M, March CM, et al. Clinical and laboratory predictors of clomiphene response. Fertil Steril, 1982, 37: 168-174.
7. Hughes E, Collins J, Vandekerckhove P, et al. Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea. Cochrane Database Syst Rev, 2000 (2) (CD000056).
8. Pritts EA. Treatment of the infertile patient with polycystic ovarian syndrome. Obstet Gynecol Surv, 2002, 57(9): 587–597.
9. Norman RJ, Dewailly D, Legro RS, et al. Polycystic ovary syndrome. Lancet, 2007, 370(9588): 685-697.
10. Stein IF, Cohen MR. Surgical treatment of bilateral polycystic ovaries. Am J Obstet Gynecol, 1939, 38: 465-473.
11. Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil Steril, 1984, 49: 956-960.
12. Api M, Gorgen H, Certin A. Laparoscopic ovarin drilling in polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol, 2005, 119(1): 76-81.
13. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod, 2004, 19(1): 41-47.
14. Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7( 27): iii-x, 1-173.
15. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. J Epidemiol Community Health, 1998, 52(6): 377-384.
16. Alieva EA, Pshenichnikova Tla, Gasparov AS. Results of laparoscopy in patients with polycystic ovary syndrome after surgical treatment, akush ginekol, 1990, 7: 63-66.
17. Kentaro T, Nobuyuki K, Fuminori K, et al. A comparative study using early second-look laparoscopic evaluation of postoperative adhesion formation between two surgical procedures for polycystic ovarian syndrome. Obstet Gynecol Surv, 2007, 62(7): 443-445.
18. 冯淑英, 邝健全, 翁梅英, 等. 两种手术方式治疗多囊卵巢综合征的远期疗效追踪比较. 中山大学学报(医学科学版), 2004, 25(3): 260-263.
19. 童莉, 卢海明, 朱进梅, 等. 多囊卵巢综合征所致不孕症腹腔镜手术与开腹手术的对比研究. 实用医学杂志, 2005, 21(20): 2321-2322.
20. 于红, 任慕兰. 两种手术方式治疗多囊卵巢综合征. 东南大学学报, 2004, 23(6): 417-418.
21. Buttram VC Jr, Vaquero C. Post-ovarian wedge resection adhesive disease. Fertil Steril, 1975, 26(9): 874-876.
22. Amer S A, Gopalan V, Li T C, et al. Long term follow-up of patiens with polycystic ovarian syndrome after laparoscopic ovarian drilling: clinical outcome. Hum Reprod, 2002, 17(8): 2035-2042.
23. The American Fertility society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril, 1988, 49(6): 944-955.
24. Creenblatt EM, Casper RF. Adhesion formation after laparoscopic ovarian cautery for polycystic ovarian syndrome: lack of correlation with pregnancy rate. Fertil Steril, 1993, 60(2): 766-770.
25. 张梅莹, 狄文. 手术治疗多囊卵巢综合征的评估. 中国妇幼健康研究, 2007, 18(1): 51-54.
26. Dabirashrafi H. Complication of laparoscopic ovarian cauterization. Fertil Steril, 1989, 52: 878-880.
27. Mike Clark. 非随机对照试验和诊断性试验准确度系统评价的新挑战. 中国循证医学杂志, 2006, 6(4): 240-242.

Chinese Journal of Evidence-Based Medicine

Laparoscopic Surgery versus Laparotomy for Women with Polycystic Ovarian Syndrome: A Systematic Review

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