Outcomes of surgical practice on tubo-ovarian abscess in an academic hospital

Abstract

Objectives: We aimed to analyseour experience in the surgical management of tubo-ovarian abscess at a tertiary hospital.

Methods: Data from patients who underwent laparoscopy or laparotomyfor treatment of tubo-ovarian abscess were retrospectively analyzed. The clinical and surgical outcomes of patients with tubo-ovarian abscess were compared according to the applied surgical approach.

Results: The mean largest diameter of the abscess in the laparoscopy and laparotomy groups were similar (p = 0.520). The mean day for total antibiotic use was significantly shorter in the laparoscopy group (10.00 ± 4.37 day vs 17.91 ± 6.59 day; p = 0.002). All cases in the laparotomy group needed to change the antibiotic regimen, but it was needed only in 28.58% of patients in the laparoscopy group. However, preoperative fever and pulse rate was significantly higher in laparotomy group than in the laparoscopy group (p = 0.004, p = 0.014; respectively). There was no statistical difference in terms of applied surgical procedure betweenthetwo groups. The most applied surgical procedure was abscess drainage in both of the groups (71.42%, 90.90%; respectively). The median operation time in patients with laparoscopy was statistically shorter than in patients with laparotomy (65.50 [58-93] minutes vs 84 [74-90] minutes, p = 0.048). In comparison of postoperative complications between two groups, there was no statistically significant difference. We observed statistically significant declination in white blood cell count and C-reactive protein values at the postoperative 7th day in all patients (p < 0.001 and p < 0.001, respectively).

Conclusions: In terms of surgical approach for tubo-ovarian abscess, laparoscopy is more effective than laparotomy for shorter duration of postoperative antibiotic use, operation time and length of hospital stay.

Keywords

• Laparoscopy
• laparotomy
• pelvic inflammatory disease
• surgical approach
• tubo-ovarian abscess

References

1. 1. Fouks Y, Cohen Y, Tulandi T, Meiri A, Levin I, Almog B, et al. Complicated clinical course and poor reproductive outcomes of women with tubo-ovarian abscess after fertility treatments. J Minim Invasive Gynecol 2019;26:162-8.
2. 2. Tao X, Ge SQ, Chen L, Cai LS, Hwang MF, Wang CL. Relationships between female infertility and female genital infections and pelvic inflammatory disease: a population-based nested controlled study. Clinics 2018;73:e364.
3. 3. Fouks Y, Cohen A, Shapira U, Solomon N, Almog B, Levin I. Surgical intervention in patients with tubo-ovarian abscess: clinical predictors and a simple risk score. J Minim Invasive Gynecol 2019;26:535-43.
4. 4. Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64:1-137.
5. 5. Brun JL, Graesslin O, Fauconnier A, Verdon R, Agostini A, Bourret A, et al. Updated French guidelines for diagnosis and management of pelvic inflammatory disease. Int J Gynaecol Obstet 2016;134:121-5.
6. 6. Jaiyeoba O, Lazenby G, Soper DE. Recommendations and rationale for the treatment of pelvic inflammatory disease. Expert Rev Anti Infect Ther 2011;9:61-70.
7. 7. Chan GMF, Fong YF, Ng KL. Tubo-ovarian abscesses: epidemiology and predictors for failed response to medical management in an Asian population. Infect Dis Obstet Gynecol 2019;2019:4161394.
8. 8. Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines. J Miss State Med Assoc 2015;56:372-5.

9. 9. Ross J, Judlin P, Jensen J; International Union against sexually transmitted infections. 2012 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS 2014;25:1-7.
10. 10. Henry-Suchet J. Laparoscopic treatment of tubo-ovarian abscess: thirty years' experience. J Am Assoc Gynecol Laparosc 2002;9:235-7.
11. 11. Hsiao SM, Hsieh FJ, Lien YR. Tubo-ovarian abscesses in postmenopausal women. Taiwan J Obstet Gynecol 2006;45:234-8.
12. 12.Rosen M, Breitkopf D, Waud K. Tubo-ovarian abscess management options for women who desire fertility. Obstet Gynecol Surv 2009;64:681-9.
13. 13. Farid H, Lau TC, Karmon AE, Styer AK. Clinical characteristics associated with antibiotic treatment failure for tubo-ovarian abscesses. Infect Dis Obstet Gynecol 2016;2016:5120293.
14. 14. Akkurt MÖ, Yalçın SE, Akkurt İ, Tatar B, Yavuz A, Yalçın Y, et al. The evaluation of risk factors for failed response to conservative treatment in tubo-ovarian abscesses. J Turkish Ger Gynecol Assoc 2015;16:226-30.
15. 15. Venn A, Watson LF, Hemminki E, Healy D, Bruinsma FJ. Mortality in a cohort of IVF patients. Hum Reprod 2001;16:2691-6.
16. 16. Dewitt J, Reining A, Allsworth JE, Peipert JF. Tuboovarian abscesses: is size associated with duration of hospitalization & complications?. Obstet Gynecol Int 2010;2010:847041.
17. 17. Topçu HO, Kokanali K, Güzel AI, Tokmak A, Erkilinç S, Ümit C, et al. Risk factors for adverse clinical outcomes in patients with tubo-ovarian abscess. J Obstet Gynaecol 2015;35:699-702.
18. 18. Facy O, Paquette B, Orry D, Santucci N, Rat P, Rat P, et al. Inflammatory markers as early predictors of infection after colorectal surgery: the same cut-off values in laparoscopy and laparotomy? Int J Colorectal Dis 2017;32:857-63.
19. 19. Jacobi CA, Ordemann J, Zieren HU, Volk HD, Bauhofer A, Halle E, et al. Increased systemic inflammation after laparotomy vs laparoscopy in an animal model of peritonitis. Arch Surg 1998;133:258-62.
20. 20. Protopapas AG, Diakomanolis ES, Milingos SD, Rodolakis AJ, Markaki SN, Vlachos GD, et al. Tubo-ovarian abscesses in postmenopausal women: gynecological malignancy until proven otherwise? Eur J Obstet Gynecol Reprod Biol 2004;114:203-9.
21. 21. Yagur Y, Weitzner O, Man-El G, Schonman R, Klein Z, Fishman A, et al. Conservative management for postmenopausal women with tubo-ovarian abscess. Menopause 2019;26:793-6.
22. 22. Güngördük K, Guzel E, Asicioǧlu O, Yildirim G, Ataser G, Ark C, et al. Experience of tubo-ovarian abscess in western Turkey. Int J Gynecol Obstet 2014;124:45-50.