Clinical value of early laparoscopic therapy in the management of tubo‑ovarian or pelvic abscess

Abstract

Broad-spectrum antibiotics are the conservative treatment for tubo-ovarian abscess (TOA) or pelvic abscess, but the failure rate of antibiotic therapy remains higher in patients with a larger abscess. The present study aimed to evaluate the clinical value of early laparoscopic therapy in the management of TOA or pelvic abscess. A total of 100 patients were enrolled and their medical records were retrospectively analyzed after excluding 6 patients with malignant diseases. Based on the treatment they had received, the patients were divided into a conservative treatment group (n=41) and an early laparoscopic treatment group (n=53). In the conservative treatment group, 21 patients (51.2%) finally received laparoscopic exploration (late laparoscopic treatment group), and 20 patients (48.8%) achieved a success of antibiotic therapy (successful antibiotic therapy group). The cut-off value of abscess size for predicting antibiotic treatment failure was determined using receiver operating characteristic curve analysis. Multivariate logistic regression analyses were used to explore the association between the clinical variables and antibiotic therapy failure in conservative treatment group. The durations of elevated temperature >38.0°C and hospitalization were significantly longer in the conservative treatment group than those in the early laparoscopic treatment group (all P<0.001). The patients in the late laparoscopic treatment group had a larger abscess size than those in the successful antibiotic therapy group (6.2±1.8 cm vs. 4.8±1.4 cm, P=0.008). An abscess diameter of 5.5 cm was obtained as the cut-off of antibiotic failure, and the sensitivity and specificity were 81.0 and 85.0%, respectively. An abscess diameter of ≥5.5 cm was independently associated with antibiotic failure (odds ratio=5.724; 95%CI: 2.025–16.182; P=0.001). In conclusion, early laparoscopic treatment was associated with a better clinical prognosis than conservative treatment and late laparoscopic therapy for TOA or pelvic abscess patients.

Emergency treatment in gynecology using different methods of surgery

“…As mentioned above, laparoscopy refers to minimally invasive treatments in surgical practice, in contrast to surgical interventions by laparotomy [11,12]. This is confirmed by the data obtained during the study in group 1.…”

Outcomes of Minimally Invasive Management of Tubo-ovarian Abscess: A Systematic Review

“…Laparoscopic drainage of TOAs may be preferred as the minimally invasive surgical technique of choice for draining TOAs [4,5]. One key advantage of laparoscopy is its use in diagnosis, as it allows for removal of necrotic tissue and sample acquisition for pathology [1,6]. Although there is evidence that laparoscopic intervention is highly effective if done early in the course of TOA management [6,8], clinicians must be mindful of the risks of anesthesia and other potential risks to fertility for patients who have not yet completed their families [5,24].…”

Systematic Review and Meta-Analysis of Complications after Laparoscopic Surgery and Open Surgery in the Treatment of Pelvic Abscess

“…Laparoscopic surgery provides the physiological benefits of tiny incisions, less bleeding, and less damage as compared to standard open laparotomy surgery [ 14 ]. Can, however, laparoscopic surgery prevent organ damage during pelvic abscess treatment?…”