Effectiveness and Safety of Postoperative Medical Treatments Following Fertility-Preserving Surgery for Endometriosis: A Network Meta-Analysis.

Abstract

Endometriosis (EMs) is a common gynaecological condition with high recurrence rates after fertility-preserving laparoscopic surgery, and optimal postoperative medical treatment remains unclear. To evaluate the efficacy and safety of various postoperative medical treatments in reducing recurrence, pain and adverse events in EMs patients after fertility-preserving surgery. PubMed, Web of Science, CENTRAL and Embase databases searched until August 1, 2024. Randomised controlled trials (RCTs) involving women aged 20-45 years post-fertility-preserving laparoscopic surgery, comparing single postoperative medications with a minimum follow-up of 2 months. Two reviewers independently extracted data and assessed quality using ROB 2.0 and CINeMA. Bayesian network meta-analysis calculated odds ratios (OR) and mean differences (MD) for recurrence rates, VAS pain reduction and adverse events. Sixteen RCTs (n = 1605 participants) evaluated 10 drugs: danazol, desogestrel, dienogest, gestrinone, goserelin, leuprolide, LNG-IUS, medroxyprogesterone, oral contraceptives and triptorelin. Only LNG-IUS significantly reduced recurrence rates (OR 0.12, 95% CI 0.02-0.63) and showed the greatest reduction in VAS pain scores (MD -24.96, 95% CI -41.76 to -8.75). Danazol significantly increased weight gain, and goserelin increased hot flashes. LNG-IUS combined with laparoscopic surgery appears most effective in reducing recurrence and pain in EMs patients. Danazol and goserelin should be used cautiously due to notable adverse effects.