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?

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.

Pelvic abscess – to drain or not to drain?

“…In a retrospective cohort study ( n = 48), hospitalization was longer in laparotomy ( n = 30, 7.5 days) than the MAS group ( n = 18, 4.5 days) ( P = 0.035). Three bowel injuries (10%) were sustained in the laparotomy and none in the MAS group [30 ▪▪ ]. Postoperative complications did not differ between the groups.…”

“…Recently, Sönmezer et al [30 ▪▪ ] also recommended early laparoscopic management within 48 h of diagnosis for subfertile patients: four out of seven patients who developed pelvic abscess post oocyte retrieval and who underwent early MAS intervention conceived with frozen-thawed embryo transfer, in a retrospective 5-year cohort study ( n = 48).…”

“…Women with endometriosis are more likely to develop severe PID leading to pelvic abscess formation, which is thought to be multifactorial: Endometrioma cyst walls being more vulnerable to bacterial invasion than healthy ovarian cortex; The ‘chocolate-cyst’ fluid provides an environment for bacteria to multiply and the proposed possible link to immune dysfunction playing a role in the aetiology of endometriosis [30 ▪▪ ,38].…”

Tubal Pathologies and Fertility Outcomes: A Review

“…Tubo-ovarian abscesses have a negative impact on ovarian function, with poor pregnancy rates observed following TOA [ 29 ]. Infertile women may be candidates for early laparoscopic intervention to maximize their chances of pregnancy after a future frozen-thawed embryo transfer [ 30 , 31 ].…”