Minimally invasive approach of tubo-ovarian abscesses

Silva, Fátima; Castro, Janice; Godinho, Cristina; Gonçalves, Jurema Ribeiro Luiz; Ramalho, Graça; Valente, Francisco

doi:10.1590/so100-720320150005257

Cited by 16 publications

(6 citation statements)

References 13 publications

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“…To our knowledge, there is no standard comparison of the surgical outcomes of all minimally invasive modalities in the literature. 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].…”

Section: Discussionmentioning

confidence: 99%

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

Goje

Markwei

Kollikonda

et al. 2021

Journal of Minimally Invasive Gynecology

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To compare the success rate, complications, and hospital length-of-stay of 3 modalities of minimally invasive management of tubo-ovarian abscesses (TOAs): laparoscopy, ultrasound-guided drainage, and computed tomography −guided drainage. Data Sources: Electronic-based search in PubMed, EMBASE, Ovid MEDLINE, Google Scholar, and Cochrane Central Register of Controlled Trials, using the following Medical Subject Heading terms: "minimally invasive surgical procedures," "drainage," "abscess," "tubo-ovarian," "ovarian diseases," and "fallopian tube diseases." Methods of Study Selection: Of the 831 articles in the initial results, 10 studies were eligible for inclusion in our systematic review. Tabulation, Integration, and Results: A total of 975 patients were included in our study; 107 (11%) had laparoscopic drainage procedures, and 406 (42%) had image-guided (ultrasound or computed tomography) drainage of TOAs. Imageguided TOA drainage had higher success rates (90%−100%) than laparoscopic drainage (89%−96%) and the use of antibiotic treatment alone (65%−83%). Patients treated with image-guided drainage had no complications (for up to 6 months of follow-up) and shorter lengths of hospital stay (0−3 days on average) compared with laparoscopic drainage (5−12 days) or conservative management with antibiotics alone (7−9 days). Conclusion: Although conservative management of TOAs with antibiotics alone remains first-line, our review indicates that better outcomes in the management of TOA were achieved by minimally invasive approach compared with conservative treatment with antibiotics only. Of the minimally invasive techniques, image-guided drainage of TOAs provided the highest success rates, the fewest complications, and the shortest hospital stays compared with laparoscopy. The low magnitude of evidence in the included studies calls for further randomized trials. This systematic review was registered in the International Prospective Register of Systematic Review (register, http://www.crd.york.ac.uk/PROSPERO;CRD 42020170345).

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Section: Discussionmentioning

confidence: 99%

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

Goje

Markwei

Kollikonda

et al. 2021

Journal of Minimally Invasive Gynecology

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“…Although it is a less traumatic treatment, transvaginal or percutaneous drainage was reported as an alternative effective treatment for TOA and the effective response rates reached 88.5-100% [4,38,39]. On the other hand, it is difficult to obtain tissue specimens for pathologic diagnosis during transvaginal or percutaneous drainage.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Adverse Events of Early Laparoscopic Therapy versus Conservative Treatment for Tubo-Ovarian or Pelvic Abscess: A Single-Center Retrospective Cohort Study

Chu

Liang

et al. 2019

Gynecol Obstet Invest

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Background/Aim: We aimed to assess the value of early laparoscopic therapy in management of tubo-ovarian abscess (TOA) or pelvic abscess. Methods: This was a retrospective study of all consecutive patients who were initially diagnosed with TOA or pelvic abscess at the local hospital between January 2010 and December 2014. The risks of operation and recurrence were analyzed using logistic analyses. Results: The durations of body temperature > 38.0°C (p = 0.001) and hospitalization (p < 0.001) were longer in the conventional group versus the early laparoscopy group. In the conventional group, 15 (50%) patients finally underwent laparoscopic exploration. The abscess size in the late laparoscopic group was significantly larger than the successful antibiotic treatment group (6.3 ± 1.5 vs. 4.9 ± 1.2 cm, p = 0.010). Abscess > 5.5 cm was independently associated with antibiotic failure (OR 4.571; 95% CI 1.612–12.962). Compared with late laparoscopy, early laparoscopy was associated with a shorter operation time (p = 0.037), less blood loss (p = 0.035), and shorter durations of body temperature > 38.0°C (p < 0.001) and hospitalization (p < 0.001). The cost was the lowest in the patients successfully treated conservatively. Conclusion: Early laparoscopic treatment is associated with shorter time of fever resolution, shorter hospitalization, and less blood loss compared with conventional treatment for TOA or pelvic abscess.

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“…In recent years, aggressive surgical treatment has been considered to be required in a proportion of patients with TOA. In particular, the development of minimally invasive techniques has greatly advanced the surgical treatment of TOA (11). However, whether patients benefit from early laparoscopic surgery remains controversial (12).…”

Section: Introductionmentioning

confidence: 99%

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

Jiang¹,

Shi

Miao³

et al. 2019

Exp Ther Med

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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.

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Minimally invasive approach of tubo-ovarian abscesses

Cited by 16 publications

References 13 publications

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

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

Effectiveness and Adverse Events of Early Laparoscopic Therapy versus Conservative Treatment for Tubo-Ovarian or Pelvic Abscess: A Single-Center Retrospective Cohort Study

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

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