Laparoscopic management of tube-ovarian abscesses - Retrospective analysisof 60 cases

Background: The laparoscopic management of tube-ovarian abscesses (TOA) was evaluated. The study sought to answer the following question: Does operati ve laparoscopy with only incision of the abscess cavity and lavage (organ-p reserving treatment) improve intraoperative and postoperative safety and lo ng-term prospects of fertility as compared with laparoscopic salpingectomy or salpingo-oophorectomy (ablative treatment)? Methods: A retrospective chart review of 60 patients with TOA undergoing la paroscopic treatment in combination with broad-spectrum antibiotics from 19 94 to 1998 was performed. Patients not wishing to have children underwent s alpingectomy or salpingo-oophorectomy, whereas patients wishing to remain f ertile were treated by means of an organ-preserving procedure. To investiga te the operative and reproductive outcome, patients were interviewed by tel ephone. Results: Of 60 women with TOA, 25 were treated laparoscopically, preserving the internal genital organs, and 35 underwent ablative treatment. Apart fr om one postoperative readmission because of lower pelvic pain in the organ- preserving group, there were no operative complications or serious systemic sequelae. In contrast, there was a significantly higher incidence of intra operative and postoperative complications when ablative treatment was perfo rmed: one intestinal perforation requiring subsequent laparotomy, four sero sal lesions, two lesions of the greater omentum, two lacerated collaterals of the internal iliac artery, one postoperative fever higher than 38 degree sC for 2 days, two bowel obstructions, one thrombosis of the upper leg, and one thrombosis of the lower leg. There were no significant differences bet ween the two patient groups in body mass index, duration of pelvic pain, la boratory findings at admission, ultrasonic assessment of abscess size, and the extent of the abscess at laparoscopy. Conclusions: When laparoscopic treatment of TOA is per-formed, organ-preser ving treatment should be chosen irrespective of the patient's age or desire to have children because of the risk of complications.