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Use of fluids and pharmacological agents (medicinal drugs) to prevent the formation of adhesions (scar tissue) after surgery of the female pelvis

Review question: This Cochrane systematic review evaluated all fluid and pharmacological agents that aim to prevent adhesion formation after gynaecological surgery (gels were defined as fluid agents).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Postoperative procedures for improving fertility following pelvic reproductive surgery

There is insufficient evidence to show the benefit or harm of routine hydrotubation or second‐look laparoscopy following surgery on a woman's reproductive system. Surgery to correct tubal damage is undertaken to improve pregnancy and live birth rates. Laparoscopy (where the abdominal organs are examined through a small surgical cut in the abdomen) to treat postoperative adhesions and postoperative hydrotubation (flushing out of the fallopian tubes) have been used to improve the results of tubal surgery. The review of trials found there is insufficient evidence to support the routine practice of hydrotubation or this second‐look laparoscopy after pelvic reproductive surgery. More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Not enough evidence to support the use of surgical nerve interruption for dysmenorrhoea

Dysmenorrhoea (painful menstrual cramps) is a common problem. The contraceptive pill and anti‐inflammatory drugs (NSAIDs) are effective treatments in 80% of women with dysmenorrhoea but for others surgery is a considered option. Uterine nerve ablation (UNA) and presacral neurectomy (PSN) both involve surgical interruption of the sensory nerve fibres near the cervix to block the pain pathway. The review of trials found there was only limited evidence to support the use of surgery for primary dysmenorrhoea and little evidence for its use in women with endometriosis. No adverse effects were found with UNA but PSN was found to cause treatable constipation. More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Barrier agents for adhesion prevention after gynaecological surgery

This review of trials assessed the effects of barriers agents on pelvic pain, live birth and adhesion formation after pelvic surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Managing acute lower abdominal pain in women of childbearing age

Review question: Cochrane authors reviewed available evidence on the use of laparoscopy to manage acute lower abdominal pain, non‐specific lower abdominal pain or suspected appendicitis in women of childbearing age. We found 12 studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Excisional surgery versus ablative surgery for ovarian endometriomata

Endometriomata are benign growths of the ovary. Evidence suggests that surgery to remove the endometrioma provides better results than draining and destroying the lining of the cyst with regard to the recurrence of the cyst, pain symptoms and also the chance of a spontaneous pregnancy in women who were previously subfertile. Surgery to excise the cyst should be the favoured surgical approach. Evidence that one technique is favoured in women who desire to conceive and who seek in vitro fertilization (IVF) treatment is however lacking. An additional randomised trial demonstrated that in women trying to conceive the ovarian response to stimulation, as part of fertility treatment, is better in women who have undergone surgery to remove the cyst rather than draining and destroying the endometrioma. The subsequent likelihood of pregnancy was not affected.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Testing for endometriosis

Endometriosis is often only diagnosed and treated late. If you are thought to have endometriosis it is important to decide what examinations are actually needed. More invasive procedures such as an examination of the inside of your abdomen (laparoscopy) are not always necessary to help decide how to best treat the symptoms, and they are associated with risks.In endometriosis, the lining of the womb (endometrium) also grows outside the womb. This endometrial tissue is benign (non-cancerous) and does not always cause noticeable pain. Endometriosis often first becomes noticeable if it causes considerable pain, if the tissue sticks together and adhesions form, or if it makes it difficult to get pregnant.Severe period pain, pain during or after sex and tenderness in parts of the pelvis are all typical signs of endometriosis.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 7, 2014

Techniques for pelvic surgery to improve fertility

Damage to the fallopian tubes is a common cause of women having difficulty conceiving. Until assisted conception techniques such as in‐vitro fertilisation (IVF) were developed the only medical treatment available to improve the chances of getting pregnant in this situation was by operating on the tubes. Such surgery has become much less common since the advent of IVF and most of the data about the results of this intervention are more than 20 years old. Women today still undergo tubal surgery if the doctor considers the prognosis is good or if IVF is not available to patients. If surgery is undertaken, various techniques have been advocated to try to enhance surgery and the pregnancy rate. These include the use of magnification including microsurgical techniques, laparoscopic surgery, laser or electrodiathermy to minimise blood loss and scarring and positioning a prosthesis around the tube. The purpose of this review is to determine the evidence to justify the use of tubal surgery, and the techniques used.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Surgery for upper tract transitional cell carcinoma

Upper tract transitional cell carcinoma is an uncommon cancer mainly affecting the draining system of the kidney (kidney pelvis) and ureter (the tube through which urine passes from the kidney to the bladder). The main treatment approach for this condition is surgical removal of the malignant area. There are a number of surgical techniques for this procedure and the aim of this review was to compare them and determine which was the most effective in terms of surgical ease, patient morbidity, clinical outcome and cost. Our search of the literature found no high quality evidence comparing different surgical techniques. Evidence from one small randomised trial and observational studies suggests that laparoscopic surgical intervention may reduce blood loss, post‐operative pain and hospital stay. However, the quality of the evidence is poor and, therefore, it is not possible to recommend the most effective surgical procedure to replace the existing clinical practice for managing upper tract transitional cell carcinoma.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Surgical approach to hysterectomy for benign gynaecological diseases

Cochrane authors evaluated which is the most effective and safe surgery for hysterectomy in women with benign gynaecological disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Keyhole laparoscopic or open surgery for rectal cancer

Colorectal (large bowel) cancer including rectal cancer is the third most common cause of cancer deaths in the western world. The risk of developing rectal cancer increases with age and is most common in people around 70 years of age. The treatment consists of complete surgical resection of the tumour and surrounding tissue by a technique called total mesorectal excision (TME), sometimes combined with chemotherapy and radiotherapy. This surgery can be performed by either normal open abdominal surgery with a large incision or by keyhole laparoscopic surgery with several small incisions for the instruments and camera. For colon cancer, laparoscopic surgery is proven to result in faster postoperative recovery, fewer complications and better cosmetic results. These results are expected to be equal for rectal surgery. However, surgery for rectal cancer is technically more difficult than for colon cancer due to the location deeper in the pelvis and close to important nerves. Therefore a complete and safe resection of the tumour should be guaranteed, this is important to reduce the risk of recurrence of the tumour and could be tested by assessing recurrence rates and patient survival in the long term.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Laparoscopic entry techniques

Cochrane review authors evaluated the benefits and risks of different laparoscopic entry techniques in gynaecological and non‐gynaecological surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Uterine fibroids: Surgery

Using medication to treat fibroid symptoms usually only helps for as long as it is taken. Many women who have more severe pain and heavy menstrual bleeding end up considering surgery as an option. There are a number of different types of surgical treatments, each with its own pros and cons.Surgery is done in the hope that it can permanently stop the symptoms of uterine fibroids, and some women do experience long-term relief. But as with any other type of surgery, there are always benefits and risks. What you think about the different advantages and disadvantages will determine whether surgery could be an option, and if so, what kind. The size, number and location of the fibroids will also influence which type of treatment should be used. Not all types of surgery are suitable for women who still want to conceive.Your doctor may recommend taking hormones such as GnRH analogues several weeks before having surgery. These kinds of hormone analogues are used to shrink the fibroids, minimizing the strain put on the uterus and making the procedure as gentle as possible. This is the same reason that the drug ulipristal acetate is sometimes used.Removing individual fibroids is not a good idea if it might cause too much scarring on the uterus or if the risk of bleeding during or after surgery is too great. Plus, it is not always absolutely clear that the symptoms will improve after surgery. In these cases a hysterectomy (surgical removal of the uterus) is an option – or possibly another non-surgical treatment option such as fibroid embolization. Fibroid embolization cuts off the blood supply to the fibroid, causing it to shrink.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 22, 2014

Imaging tests for the non‐invasive diagnosis of endometriosis

Women with endometriosis have endometrial tissue (the tissue that lines the womb and is shed during menstruation) growing outside the womb within the pelvis, causing chronic abdominal pain and difficulty conceiving. Currently, the only reliable way of diagnosing endometriosis is to perform laparoscopic surgery and visualise the endometrial deposits inside the abdomen. Because surgery is risky and expensive, imaging tests have been assessed for their ability to detect endometriosis non‐invasively. An accurate imaging test could lead to the diagnosis of endometriosis without the need for surgery, or it could reduce the need for surgery, so only women who were most likely to have endometriosis would require it. Furthermore, if imaging tests could accurately predict the location of endometriotic lesions, surgeons would have the information they need to plan and improve their surgical approach. Other non‐invasive ways of diagnosing endometriosis by using urine, blood and endometrial and combination tests have been evaluated in separate Cochrane reviews from this series.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Combination of different types of tests for the non‐invasive diagnosis of endometriosis

Women with endometriosis have endometrial tissue (the tissue that lines the womb and is shed during menstruation) growing outside the womb within the pelvic cavity. This tissue responds to reproductive hormones, causing painful periods, chronic lower abdominal pain and difficulty conceiving. Currently, the only reliable way of diagnosing endometriosis is to perform keyhole surgery and visualise the endometrial deposits inside the abdomen. Because surgery is risky and expensive, combinations of various tests have been evaluated for their ability to detect endometriosis non‐invasively. An accurate test could lead to the diagnosis of endometriosis without the need for surgery or it could reduce the need for diagnostic surgery so only women who were most likely to have endometriosis would require it.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Blood biomarkers for the non‐invasive diagnosis of endometriosis

Women with endometriosis have endometrial tissue (the tissue that lines the womb and is shed during menstruation) growing outside the womb within the pelvic cavity. This tissue responds to reproductive hormones, causing painful periods, chronic lower abdominal pain and difficulty conceiving. Currently, the only reliable way of diagnosing endometriosis is to perform keyhole surgery and visualise the endometrial deposits inside the abdomen. Because surgery is risky and expensive, we evaluated whether the results of blood tests (blood biomarkers) can help to detect endometriosis non‐invasively. An accurate blood test could lead to the diagnosis of endometriosis without the need for surgery, or it could reduce the need for diagnostic surgery to a group of women who were most likely to have endometriosis. Separate Cochrane reviews from this series evaluate other non‐invasive ways of diagnosing endometriosis using urine, imaging, endometrial and combination tests.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Key hole‐assisted vaginal extended (radical) hysterectomy versus open radical hysterectomy for the treatment of early cervical cancer

Cervical cancer is the second most common cancer among women. A woman's risk of developing cervical cancer by 65 years of age ranges from 0.69% in developed countries to 1.38% in developing countries. In Europe, about 60% of women with cervical cancer are alive five years after diagnosis. Standard treatment for selected early cervical cancer is radical hysterectomy, involving removal of the cervix, uterus (womb) and supporting tissues (parametrium), together with the pelvic lymph glands (nodes) and a top part of the vagina (cuff). Traditionally, radical hysterectomy has been performed as open surgery for more than a century. In recent years this operation has also been performed laparoscopically (key hole surgery) to reduce the size of the abdominal incision.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Use of a levonorgestrel‐releasing intrauterine device (LNG‐IUD) for recurrence of symptoms in women who have had surgery for endometriosis

Endometriosis is the presence of endometrial tissue outside the uterus, usually in the pelvis, that can lead to infertility and pelvic pain. It is managed with surgery, hormonal medications, or a combination of both. The progestogen levonorgestrel is one such hormonal medication. The aim of this review was to assess whether the use of a hormone‐releasing intrauterine device was beneficial for managing associated painful symptoms and for preventing recurrence of endometriosis following surgery. Although preliminary findings are encouraging, at this stage there is only limited evidence from three randomised trials of a beneficial role with the use of the LNG‐IUD in reducing the recurrence of painful periods following surgery for endometriosis. The strength of the evidence was graded as moderate reflecting our belief that future evidence will most likely not change these findings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Screening (PDQ®): Patient Version

Expert-reviewed information summary about tests used to detect or screen for ovarian, fallopian tube, and primary peritoneal cancers.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: February 8, 2017

Cervical Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of cervical cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 14, 2016

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Systematic Review Methods in PubMed

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