We performed a systematic review and meta-analysis with the aim to answer whether operative laparoscopy is an effective treatment in a woman with demonstrated endometriosis compared with alternative treatments. Moreover, we aimed to assess the risks of operative laparoscopy compared with those of alternatives. In addition, we aimed to systematically review the literature on the impact of patient preference on decision making around surgery. Data Sources: We searched MEDLINE, Embase, PsycINFO, ClinicalTrials.gov, CINAHL, Scopus, OpenGrey, and Web of Science from inception through May 2019. In addition, a manual search of reference lists of relevant studies was conducted. Methods of Study Selection: Published and unpublished randomized controlled trials (RCTs) in any language describing a comparison between surgery and any other intervention were included, with particular reference to timing and its impact on pain and fertility. Studies reporting on keywords including, but not limited to, endometriosis, laparoscopy, pelvic pain, and infertility were included. In the anticipated absence of RCTs on patient preference, all original research on this topic was considered eligible. Tabulation, Integration, and Results: In total, 1990 studies were reviewed. Twelve studies were identified as being eligible for inclusion to assess outcomes of pain (n = 6), fertility (n = 7), quality of life (n = 1), and disease progression (n = 3). Seven studies of interest were identified to evaluate patient preferences. There is evidence that operative laparoscopy may improve overall pain levels at 6 months compared with diagnostic laparoscopy (risk ratio [RR], 2.65; 95% confidence interval [CI], 1.61−4.34; p <.001; 2 RCTs, 102 participants; low-quality evidence). Because the quality of the evidence was very low, it is uncertain if operative laparoscopy improves live birth rates. Operative laparoscopy probably yields little or no difference regarding clinical pregnancy rates compared with diagnostic laparoscopy (RR, 1.29; 95% CI, 0.99−1.92; p = .06; 4 RCTs, 624 participants; moderate-quality evidence). It is uncertain if operative laparoscopy yields a difference in adverse outcomes when compared with diagnostic laparoscopy (RR, 1.98; 95% CI, 0.84−4.65; p = .12; 5 RCTs, 554 participants; very-low-quality evidence). No studies reported on the progression of endometriosis to a symptomatic state or progression of extent of disease in terms of volume of lesions and locations in asymptomatic women with endometriosis. We Ben W. Mol reports consultancy for OvsEva, Guerbet, and Merck; grant support from Merck; travel support from Guerbet; and holds a Practitioner Fellowship from National Health and Medical Research Council. Tal Z. Jacobson reports a minor shareholding in, and clinical service fees from, Virtus Health. Neil P. Johnson reports consultancy for Myovant Sciences, Vifor Pharma, and Guerbet and research funding from AbbVie and Myovant Sciences. All remaining authors declare they have no conflict of interest.

Objectives: Coconut oil is a cheap and accessible oil for many people around the world. There are numerous advocates for the practice of oil pulling to prevent common oral diseases. Therefore determining the effectiveness of oil pulling with coconut oil could potentially have monumental benefits. This review aimed to assess the effect of oil pulling with coconut oil in improving oral health and dental hygiene. Data: We included randomized controlled trials comparing the effect of oil pulling with coconut oil on improving oral health and dental hygiene. No meta-analysis was performed due to the clinical heterogeneity and differences in the reporting of data among the included studies. Sources: Six electronic databases were screened: PubMed, Medline, EMBASE, AMED, CENTRAL and CINAHL. Study selection: Electronic searches yielded 42 eligible studies, of which four RCTs including 182 participants were included. The studies lasted between 7 and 14 days. Significant differences were demonstrated for a reduction in salivary bacterial colony count (p ¼ 0.03) and plaque index score (p¼<0.001). One study also demonstrated a significant difference in staining compared to using Chlorhexidine (p ¼ 0.0002). However, data was insufficient for conclusive findings, the quality of studies was mixed and risk of bias was high. Conclusion: The limited evidence suggests that oil pulling with coconut oil may have a beneficial effect on improving oral health and dental hygiene. Future clinical trials are of merit considering the universal availability of the intervention. Prospective research should have a robust design with rigorous execution to provide a higher quality of evidence. Clinical significance: Oil pulling with coconut oil could be used as a adjunct to normal preventative regimes to improve oral health and dental hygiene although further studies are needed to determine the level of effectiveness.

Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery (Review)

(Abstracted from J Minim Invasive Gynecol 2020;27:390–407) Endometriosis is an inflammatory disease characterized by endometrium-like lesions outside the uterus. Pelvic pain and infertility are hallmarks of the disorder.