Reply: Criticizing the effect of ovarian suspension on adhesions in laparoscopic surgery for endometriosis.

treatment (HT), while in the next sentence the number of cases receiving HT reached 31 cases. It seems reasonable that the patients were advised to withdraw from using any hormonal substance, and that is the third prerequisite for randomization. In addition, the use of estrogenic compounds should cease before any elective surgery in order to avoid thromboembolic accidents.More usefully, they could have added up all cases that were on HT after surgery and compared their symptoms with the other 21 be ceased that were not. Such a comparison could more accurately specify the role of HT on changes in the symptoms. If randomization had been done correctly, we would have expected that the number of suspended and unsuspended ovaries (which were 20 and 27 ovaries, respectively), and suspended ovaries on each side (which are not mentioned in this study) would be equal. The authors stated that the comparable rate of post-operative adhesions examined by transvaginal ultrasound in their study with previous studies which used laparoscopy indicated that their findings are reassuring. Such judgment would be true if they had used both diagnostic procedures (transvaginal ultrasound and laparoscopy) on the same cases or on a similar study population. Comparable percentages of cases with adhesions using both diagnostic procedures prove nothing. Furthermore, if we conducted a diagnostic study on the same cases and considered laparoscopy as the gold standard, the percentages of cases with false-negative and falsepositive adhesions by vaginal ultrasound may be nearly equal and this could result in a comparable percentage of adhesions by the two methods. Alternatively, maybe the cases with adhesions based on laparoscopy are healthy according to a transvaginal ultrasound and vice versa.