The application of Surgicel, a material used to help control bleeding, can reduce the chance of recurrence following surgery for ovarian endometriomas, a new study suggests.

The study, titled “A randomized controlled trial of a new technique for laparoscopic management of ovarian endometriosis preventing recurrence and keeping ovarian reserve,” was published in the Journal of Ovarian  Research.

Ovarian endometriomas are cyst-like structures (bags of fluid) that are detected in 17%–44% of people with endometriosis. These are typically dealt with surgically, either by drainage (removing the fluid) and ablation of the cyst wall or a cystectomy (removing the whole structure), but the procedures may reduce a person’s reproductive potential. As many as a third of those who undergo such procedures also experience a recurrence later in life.

Researchers investigated whether using Surgicel during these procedures might reduce recurrence and/or improve ovarian health and reserve. Surgicel is an oxidized regenerated cellulose agent that looks like gauze, and can promote blood clotting and reduce bleeding. Importantly, it is less expensive and causes less damage than other methods to reduce bleeding in surgery, i.e. cauterizing using electricity.

For the study, two hundred people, from 20–35 years old, with ovarian endometriomas were recruited and randomized to undergo drainage or a cystectomy, with or without the placement of four to eight pieces of Surgicel, as needed, in a drained cyst or remaining ovarian tissue. The 50 patients in each of the four groups were followed up for two years. All groups were similar in terms of age, demographics, and clinical presentation.

Among patients who were treated with drainage and Surgicel, the recurrence rate after two years was 10.9%, a result significantly lower than the rate of 27.1% in patients who received drainage alone. Similarly, there was a significantly lower recurrence rate among those who received a cystectomy plus Surgicel (9.1%) compared with those who received a cystectomy without Surgicel (24.4%).

Over the two-year study period, 17 women became pregnant, including 10 who were treated with Surgicel and seven who weren’t. This difference was not statistically significant, so no conclusions could be made about Surgicel’s effect on reproductive health. However, this was a relatively short-term study, so further research will be needed to fully assess how Surgicel use impacts reproductive capabilities, the researchers said.

Anti-Mullerian hormone levels and antral follicle count, two measurements of ovarian health, were also assessed. Surgicel was significantly beneficial for patients who underwent drainage, but did not seem to have an effect on individuals who got a cystectomy. In all groups, the values ranged widely for individual patients, so more research will be needed to thoroughly assess the use of Surgicel on ovarian health.

Surgicel was also found to be generally safe, with no complications or side effects recorded.

“The present study has demonstrated that Surgicel reduces effectively the recurrence risk of endometriomas following either laparoscopic cystectomy or drainage,” the researchers said.

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Significantly better health outcomes are reported for both infants and mothers living with HIV when male partners are co-enrolled in antenatal care with the mother. In this clinic-randomised control trial, infants were 4.55 times less likely to become infected with HIV when male partners were actively involved in prevention of mother-to-child transmission (PMTCT) programmes during pregnancy.

The study took place across 12 randomly selected community health centres in Gert Sibande and Nkangala districts in Mpumalanga province, South Africa.

Researchers compared standard of care PMTCT programs with a new intervention which used group sessions and individual counselling to encourage adherence to treatment, HIV testing of family members, disclosure and partner communication alongside other outcomes.

In the first phase women were enrolled in the intervention or the standard of care alone, while in the second phase they were invited to enrol with their male partners.

The primary outcomes of the trial were infant HIV status, assessed at 12 months by DNA polymerase chain reaction (PCR) test, and infant survival, defined as miscarriage or death by 12 months postpartum. They also collected data on socioeconomic status, knowledge of HIV status, depressive symptoms, HIV stigma, family planning knowledge and intimate partner violence.

A total of 1,399 participants were included in the analysis at baseline. The average (mean) age of the women in the study was 28 and 48% had completed 10 to 11 years of education. Just over half (54%) of the women were unmarried and living separately from their partner and 64% had a monthly income of at least 1,000 ZAR (~70USD). Just over half (55%) of the women had been diagnosed with HIV in this present pregnancy and 50% reported that their pregnancy was unplanned.

The analysis found that more infants became HIV-positive in Phase 1 over Phase 2, and infants whose mothers were enrolled alone had a 1.98% increased likelihood of death or becoming infected with HIV. Moreover, rates of attrition and loss to follow-up were much lower when male partners were involved.

Researchers found that on average, across both phases, women had been diagnosed with HIV 24 months prior to baseline and had been on treatment for 15 months. Male involvement and family planning knowledge were moderate, and HIV-related stigma was low. Depression rates were high, with 45% of women showing clinically significant symptoms of depression. In addition to this, approximately 15% of women reported having more than two alcoholic drinks in the past month, and 61% reported having disclosed their HIV status to their partner. However, of these demographic findings, only depressive symptoms were significantly associated with infant HIV infection at 12 months.

The study found male participation was by far the most significant factor in determining health outcomes of both mother and child, outperforming the ‘protect your family intervention’, which had no significant impact on health outcomes of mother and child compared to standard of care, when women were enrolled alone.

In discussing these findings researchers comment that “male participation in the intervention may have promoted greater male partner involvement overall, including in PMTCT and child nurturing, leading to decreased risk of infant HIV infection and mortality. Male involvement, therefore, should be emphasized in areas with high rates of HIV transmission during or after pregnancy to enhance infant outcomes among HIV-exposed infants.”

Previous programmes primarily focus on mother and child, with little emphasis on the role of the father in pre- and postpartum care. These study results support the shift in thinking and programming that looks at male partner involvement as a critical component of PMTCT.

In this study, depressive symptoms are highlighted as high-risk poor HIV-related outcomes, and interventions should focus on screening for depression in order to improve treatment adherence and decrease infant HIV infection and mortality.

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