Impacts of endometrioma type and two-different techniques of laparoscopic cystectomy on ovarian reserve by measuring anti-mullerian hormone concentration

ABSTRACT Introduction: Endometriosis caused chronic inflammation reaction, fibrosis, and adhesion resulting in anatomic distortion of pelvic organ commonly suffered by young woman. This study aims to understand the impact of the type of endometrioma and two different laparoscopic cystectomy excision techniques (“stripping” or complete excision vs. partial excision) on the ovarian reserve by measuring the anti-mullerian hormone (AMH) levels in patients with endometrioma. Method: This is an experimental study in the form of pre-test and post-test group design The subjects were patients with >3 cm endometrioma detected via transvaginal USG which were classified into two different groups, i.e., the “stripping” laparoscopic cystectomy group as control and partial excision laparoscopic cystectomy as an intervention group. Cystectomy techniques were chosen based on “formulated block sampling.” The AMH levels measurements were performed before the operation (pre-test), and post-operation levels were measured at one and three months after the procedures on both groups. The study was conducted in Bali Royal Hospital (BROS), Denpasar, Indonesia, between January 2012 and January 2018. Independent sample t-test was used to analyze the collected data. Results: There was no significant difference in the age and length of marriage between the two groups (p>0.05). Unilateral endometrioma had higher concentration of AMH compared to bilateral endometrioma before the laparoscopy (2.09±1.33 vs 1.99±1.25 ng/ml; p=0.768), 1 month after the laparoscopy (1.20±0.59 vs 1.12±0.72 ng/ml; p=0.647), as well as 3 months after the laparoscopy (1.79±0.97 vs 1.44±0.87 ng/ml; p=0.148), but they were not statistically significant (p>0.05). Based on the laparoscopy techniques, there’s no significant difference in AMH concentration before laparoscopy (1.87±1.23 vs. 2.36±1.13; p= 0.119) in both groups. Otherwise, AMH level in partial excision laparoscopic cystectomy was significantly higher (p<0.05) than in the stripping laparoscopic cystectomy, one month after (1.33±0.62 vs. 0.98±0.67 ng/ml; p=0.038), as well as three months (1.88±0.97 vs. 1.29±0.77; p=0.011) after the surgery. Conclusion: Unilateral and bilateral endometriomas have no significant difference in AMH levels. There’s also no significant difference of AMH levels before operation in both different cystectomy technique. Thus, it was found that the effect of partial excision laparoscopic cystectomy on AMH concentration was significantly lesser effect than in stripping laparoscopic cystectomy. Keyword: Endometrioma, stripping excision, AMH