Laparoscopic management of tubo-ovarian abscesses
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The laparoscopic management of tubo-ovarian abscesses (TOA) was evaluated. The study sought to answer the following question: Does operative laparoscopy with only incision of the abscess cavity and lavage (organpreserving treatment) improve intraoperative and postoperative safety and long-term prospects of fertility as compared with laparoscopic salpingectomy or salpingo-oophorectomy (ablative treatment)?
A retrospective chart review of 60 patients with TOA undergoing laparoscopic treatment in combination with broad-spectrum antibiotics from 1994 to 1998 was performed. Patients not wishing to have children underwent salpingectomy or salpingo-oophorectomy, whereas patients wishing to remain fertile were treated by means of an organpreserving procedure. To investigate the operative and reproductive outcome, patients were interviewed by telephone.
Of 60 women with TOA, 25 were treated laparoscopically, preserving the internal genital organs, and 35 underwent ablative treatment. Apart from one postoperative readmission because of lower pelvic pain in the organpreserving group, there were no operative complications or serious systemic sequelae. In contrast, there was a significantly higher incidence of intraoperative and postoperative complications when ablative treatment was performed: one intestinal perforation requiring subsequent laparotomy, four serosal lesions, two lesions of the greater omentum, two lacerated collaterals of the internal iliac artery, one postoperative fever higher than 38°C for 2 days, two bowel obstructions, one thrombosis of the upper leg, and one thrombosis of the lower leg. There were no significant differences between the two patient groups in body mass index, duration of pelvic pain, laboratory findings at admission, ultrasonic assessment of abscess size, and the extent of the abscess at laparoscopy.
When laparoscopic treatment of TOA is performed, organ-preserving treatment should be chosen irrespective of the patient’s age or desire to have children because of the risk of complications.
Key wordsComplications Laparoscopy Tuboovarian abscess
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- 1.DeWilde R, Hesseling M (1995) Tube-preserving diagnostic operative laparoscopy in pyosalpinx. Gynaecol Endosc 4: 105–108Google Scholar
- 3.Henry-Suchet J, Soler A., Loffredo V (1984) Laparoscopic treatment to tubo-ovarian abscesses. J Reprod Med 8: 579Google Scholar
- 4.Johns DA (1994) Laparoscopic treatment of tubo-ovarian abscess. In: Sutton C, Diamand M (eds) Endoscopic surgery of gynaecologists, third printing. W. B. Saunders, London, Philadelphia, Toronto, Sydney, Tokyo, pp 154–158Google Scholar
- 9.Nezhat CR (1995) Operative gynecologic laparoscopy: principles and technique. 1st ed. McGraw-Hill New York, St Louis, San Francisco, London, Milan, Sydney, Toronto, Tokyo, pp 185–201Google Scholar
- 12.Rizk P (1995) Operative laparoscopy in the management of tuboovarian abscess. J Am Assoc Gynecol Laparosc 2(4, Suppl): 46Google Scholar