الفهرس 
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Abstract
Ovarian cysts are a common gynecological problem, occurring in approximately 6.6% of reproductive age women. The decision to operate is more important in infertile patients and patients desiring further fertility. Laparoscopy is the preferred surgical technique for ovarian cystectomy because this minimally invasive technique features reduced intraabdominal adhesion, operative pain, and hospitalization times (Brun et al., 2014). Endometriosis as an enigmatic disease is most commonly found on the ovaries and presents with pelvic pain and infertility (De Ziegler et al., 2010).
Laparoscopic cystectomy for endometrioma is a favorite modality for many surgeons with the reported benefits such as lower recurrence rate and better response to ovarian stimulation (Littman et al., 2005; Moscarini et al., 2014). Based on literatures, factors affecting ovarian reserve were cyst size, recurrences, bilateral case, techniques of surgery, skill of surgeon, and hemostasis method (Reich and Abrao, 2006; Hart et al., 2008; Raffi et al., 2012; Ferrero et al., 2012).
The most common side effect of cystectomy is damage to healthy ovarian tissue; therefore, application of new techniques with lower adverse effects on ovarian reserve is a current concern. AMH level has been considered as a reliable and useful marker of ovarian reserve (Toner and Seifer, 2013).
The aim of the present study was to determine which hemostatic procedure (hemostatic suture or electrocautery) may be less harmful after laparoscopic cystectomy, based on the longterm status of the ovarian reserve.
The study population comprises females in childbearing period undergoing laparoscopic endometriotic ovarian cystectomy at Ain Shams University Maternity Hospital, Obstetric and Gynecology Department, Faculty of medicine.
Ovarian volume was measured. Antral follicles in operated ovaries was counted by to 2D ultrasound in the second or third day of the menestural cycle.
Determination of ovarian reserve by AMH and AFC was performed at the third day of the menstrual cycle befor the operation and rechecked at 3 monthes after surgery.
We found that Preoperative there was no statistically significant difference regarding the 2 groups in AMH & AFC and FSH with p-value = 0.188, 0.533 and 0.812 respectively.
While postoperative there was highly significant change regarding the 2 groups in AMH & AFC and FSH with p-value <0.001, 0.005 and 0.004 respectively.
There was statistically significant increase in AMH level in suturing group than cautery group postoperative with p-value < 0.001.
The percentage of change of AMH showed lower rate of change in suturing group than the cautery group with p-value < 0.001.
There was statistically significant increase in FSH in cautery group than suturing group postoperative with p-value 0.004.
The percentage of change of FSH showed higher rate of change in cautery group than the suturing group with p-value < 0.001.
In the current study there was statistically significant increase in AFC in suturing group than cautery group postoperative with p-value 0.005.
The percentage of change of AFC showed lower rate of change in suturing group than the cautery group with p-value = 0.001.
Our results show that laparoscopic cystectomy reduces the ovarian reserve, which is more affected by hemostatic electrocoagulation than hemostatic sutures, This adverse effect could be less if the hemostasis is achieved by suturing rest of the ovarian tissue. Therefore, suturing as a method of hemostasis should be recommended in laparoscopic surgery for ovarian endometriosis.