Hoo, WL;
(2017)
Does ovarian suspension during laparoscopic surgery for endometriosis reduce postoperative adhesions? A randomised controlled trial.
Masters thesis , UCL (University College London).
Preview |
Text (Redacted version)
Final Thesis 170809 E Version no addresses.pdf - Accepted Version Download (4MB) | Preview |
Abstract
In this thesis, I have explored complex pathology of endometriosis, described current management strategies and highlighted the common problem of postoperative pelvic adhesions, often associated with the surgical treatment of this condition. Intra-operative suspension of the ovaries to the anterior abdominal wall is a simple method used to facilitate ovarian retraction during surgery. We found in an observational (pilot) study that the prevalence of ovarian adhesions for each ovary was 56.3% after laparoscopic surgery for severe pelvic endometriosis. A prospective double-blind cross-over comparison randomised controlled trial (RCT) was completed to assess the effect of temporary ovarian suspension following laparoscopic surgery for severe pelvic endometriosis on the prevalence of postoperative ovarian adhesions. Suitable women were randomised to unilateral ovarian suspension for 36 to 48 hours in the postoperative period. A transvaginal ultrasound scan was performed three months after surgery to assess for the prevalence of ovarian adhesions. Our RCT concluded that there was no significant difference (P = 0.23) in the prevalence of postoperative ovarian adhesions between the suspended (20/52) and unsuspended (27/52) side (38.5 versus 51.9%) [odds ratio 0.56 (95% confidence interval 0.22–1.35)]. Using the ovarian suspension RCT as a basis, I have described the detailed journey of an RCT from its conception, protocol design, pilot study, trial management, analysis to publication of results. The rationale for our study design and methodology was discussed. Statistical considerations were made from the outset, which led to a pilot study. Issues surrounding the implementation of our trial including ethical approval, recruitment, consent, randomisation and details of data management were outlined. Finally, statistical analysis, conclusions, limitations and suggestions for future research were made. Current Controlled Trials: ISRCTN24242218
Archive Staff Only
 |
View Item |
