Laparoscopy versus open surgery for the surgical management of tubo-ovarian abscess (TOA). Is there a beneficial impact of early endoscopic intervention in terms of fertility rates?
, 2, 2, 1, 2, 2, 2, 2, 2
Abstract
Objectives: To compare success rates and complications in women undergoing laparoscopic versus open surgical management of tubo-ovarian abscess. We further examined whether early laparoscopic intervention has any impact on pregnancy rates in a subgroup of infertile patients following frozen-thawed embryo transfer.
Material and methods: Hospital records of 48 patients diagnosed with TOA between January 2015 and December 2020, who underwent surgical intervention or received only medical treatment were analyzed. All patients were hospitalized, and parenteral antibiotics were commenced on admission initially. Laparoscopic or open surgery was performed within 48 hours course of intravenous antibiotherapy (early intervention) or later according to the clinical findings and antibiotherapy response.
Results: Of 48 patients with TOA, 18 (37.5%) underwent laparoscopic and 30 (62.5%) underwent open surgical intervention. The median postoperative hospital stay was shorter (4.5 days vs 7.5 days, respectively; p = 0.035), and postoperative opioid analgesic requirement was lesser in the laparoscopy group compared to open surgery group (22% vs 53%, respectively; p = 0.034). Intra- and post-operative complication rates were similar between the groups. Of these 48 patients, seven were diagnosed to have TOA following oocyte retrieval, and four of these conceived with frozen thawed embryo transfer all of whom underwent laparoscopic surgery within 48 hours of diagnosis.
Conclusions: Minimal invasive surgery should be preferred even in the presence of severely adhesive and inflammatory TOA in order to improve postoperative outcomes. Moreover, early laparoscopic intervention may be considered in infertile patients with an aim to optimize pregnancy rates in a subsequent frozen-thawed embryo transfer.
Keywords: laparoscopyopen surgerypelvic inflammatory diseasetubo-ovarian abscess
References
- Munro K, Gharaibeh A, Nagabushanam S, et al. Diagnosis and management of tubo-ovarian abscesses. The Obstetrician & Gynaecologist. 2018; 20(1): 11–19.
- Shigemi D, Matsui H, Fushimi K, et al. Laparoscopic Compared With Open Surgery for Severe Pelvic Inflammatory Disease and Tubo-Ovarian Abscess. Obstet Gynecol. 2019; 133(6): 1224–1230.
- Goje O, Markwei M, Kollikonda S, et al. Outcomes of Minimally Invasive Management of Tubo-ovarian Abscess: A Systematic Review. J Minim Invasive Gynecol. 2021; 28(3): 556–564.
- Pedowitz P, Bloomfield R. Ruptured adnexal abscess (tuboovarian) with generalized peritonitis. American Journal of Obstetrics and Gynecology. 1964; 88(6): 721–729.
- To J, Aldape D, Frost A, et al. Image-guided drainage versus antibiotic-only treatment of pelvic abscesses: short-term and long-term outcomes. Fertil Steril. 2014; 102(4): 1155–1159.
- Minakami H, Hiramatsu Y, Koresawa M, et al. Japan Society of Obstetrics and Gynecology, Japan Association of Obstetricians and Gynecologists. Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2011 edition. J Obstet Gynaecol Res. 2011; 37(9): 1174–1197.
- Workowski KA, Bolan GA. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015; 64(RR-03): 1–137.
- Ross J, McCarthy GUK. National guideline for the management of pelvic inflammatory disease. British Association for Sexual Health and HIV. ; 2011.
- Ribak R, Schonman R, Sharvit M, et al. Can the Need for Invasive Intervention in Tubo-ovarian Abscess Be Predicted? The Implication of C-reactive Protein Measurements. J Minim Invasive Gynecol. 2020; 27(2): 541–547.
- Caspi B, Zalel Y, Or Y, et al. Sonographically guided aspiration: an alternative therapy for tubo-ovarian abscess. Ultrasound Obstet Gynecol. 1996; 7(6): 439–442.
- Teisala K, Heinonen PK, Punnonen R. Transvaginal ultrasound in the diagnosis and treatment of tubo-ovarian abscess. Br J Obstet Gynaecol. 1990; 97(2): 178–180.
- Aboulghar MA, Mansour RT, Serour GI. Ultrasonographically guided transvaginal aspiration of tuboovarian abscesses and pyosalpinges: an optional treatment for acute pelvic inflammatory disease. Am J Obstet Gynecol. 1995; 172(5): 1501–1503.
- Doganay M, Iskender C, Kilic S, et al. Treatment approaches in tubo-ovarian abscesses according to scoring system. Bratisl Lek Listy. 2011; 112(4): 200–203.
- Yang IJ, Wu MY, Chao KH, et al. Usage and cost-effectiveness of elective oocyte freezing: a retrospective observational study. Reprod Biol Endocrinol. 2022; 20(1): 123.
- Carlson S, Batra S, Billow M, et al. Perioperative Complications of Laparoscopic versus Open Surgery for Pelvic Inflammatory Disease. J Minim Invasive Gynecol. 2021; 28(5): 1060–1065.
- Fouks Y, Cohen Y, Tulandi T, et al. Complicated Clinical Course and Poor Reproductive Outcomes of Women with Tubo-Ovarian Abscess after Fertility Treatments. J Minim Invasive Gynecol. 2019; 26(1): 162–168.
- Chu L, Ma H, Liang J, et al. Effectiveness and Adverse Events of Early Laparoscopic Therapy versus Conservative Treatment for Tubo-Ovarian or Pelvic Abscess: A Single-Center Retrospective Cohort Study. Gynecol Obstet Invest. 2019; 84(4): 334–342.
- Aragona C, Mohamed MA, Espinola MS, et al. Clinical complications after transvaginal oocyte retrieval in 7,098 IVF cycles. Fertil Steril. 2011; 95(1): 293–294.
- Roest J, Mous HV, Zeilmaker GH, et al. The incidence of major clinical complications in a Dutch transport IVF programme. Hum Reprod Update. 1996; 2(4): 345–353.
- Elizur SE, Lebovitz O, Weintraub AY, et al. Pelvic inflammatory disease in women with endometriosis is more severe than in those without. Aust N Z J Obstet Gynaecol. 2014; 54(2): 162–165.
- Villette C, Bourret A, Santulli P, et al. Risks of tubo-ovarian abscess in cases of endometrioma and assisted reproductive technologies are both under- and overreported. Fertil Steril. 2016; 106(2): 410–415.
- Yang CC, Chen Pu, Tseng JY, et al. Advantages of open laparoscopic surgery over exploratory laparotomy in patients with tubo-ovarian abscess. J Am Assoc Gynecol Laparosc. 2002; 9(3): 327–332.
- Ashkenazi J, Farhi J, Dicker D, et al. Acute pelvic inflammatory disease after oocyte retrieval: adverse effects on the results of implantation. Fertil Steril. 1994; 61(3): 526–528.
- Buchweitz O, Malik E, Kressin P, et al. Laparoscopic management of tubo-ovarian abscesses. Surgical Endoscopy. 2000; 14(10): 948–950.
