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.