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

Jiang,Xiaofei; Shi,Mingqing; Sui,Miao; Wang,Tao; Yang,Haiyan; Zhou,Huifang; Zhao,Kai

doi:10.3892/etm.2019.7699

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

Authors:
- Xiaofei Jiang
- Mingqing Shi
- Miao Sui
- Tao Wang
- Haiyan Yang
- Huifang Zhou
- Kai Zhao
View Affiliations

Affiliations: Department of Gynecology, Xuzhou City Hospital of Chinese Medicine, Xuzhou, Jiangsu 221003, P.R. China, Department of Obstetrics and Gynecology, Lishui Hospital of Chinese Medicine, Lishui, Zhejiang 323000, P.R. China, Department of Endocrinology, Xuzhou City Hospital of Chinese Medicine, Xuzhou, Jiangsu 221003, P.R. China, Department of Science and Education, Xuzhou City Hospital of Chinese Medicine, Xuzhou, Jiangsu 221003, P.R. China, Department of Gynecology, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
Published online on: June 21, 2019 https://doi.org/10.3892/etm.2019.7699
Pages: 1115-1122
Copyright: © Jiang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

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.

View Figures

View References

1	McNeeley SG, Hendrix SL, Mazzoni MM, Kmak DC and Ransom SB: Medically sound, cost-effective treatment for pelvic inflammatory disease and tuboovarian abscess. Am J Obstet Gynecol. 178:1272–1278. 1998. View Article : Google Scholar : PubMed/NCBI
2	Rosen M, Breitkopf D and Waud K: Tubo-ovarian abscess management options for women who desire fertility. Obstet Gynecol Surv. 64:681–689. 2009. View Article : Google Scholar : PubMed/NCBI
3	Zeger W and Holt K: Gynecologic infections. Emerg Med Clin North Am. 21:631–648. 2003. View Article : Google Scholar : PubMed/NCBI
4	Kuo CF, Tsai SY, Liu TC, Lin CC, Liu CP and Lee CM: Clinical characteristics and treatment outcomes of patients with tubo-ovarian abscess at a tertiary care hospital in Northern Taiwan. J Microbiol Immunol Infect. 45:58–64. 2012. View Article : Google Scholar : PubMed/NCBI
5	Goharkhay N, Verma U and Maggiorotto F: Comparison of CT- or ultrasound-guided drainage with concomitant intravenous antibiotics vs. intravenous antibiotics alone in the management of tubo-ovarian abscesses. Ultrasound Obstet Gynecol. 29:65–69. 2007. View Article : Google Scholar : PubMed/NCBI
6	Reed SD, Landers DV and Sweet RL: Antibiotic treatment of tuboovarian abscess: Comparison of broad-spectrum beta-lactam agents versus clindamycin-containing regimens. Am J Obstet Gynecol. 164:1556–1562. 1991. View Article : Google Scholar : PubMed/NCBI
7	To J, Aldape D, Frost A, Goldberg GL, Levie M and Chudnoff S: Image-guided drainage versus antibiotic-only treatment of pelvic abscesses: Short-term and long-term outcomes. Fertil Steril. 102:1155–1159. 2014. View Article : Google Scholar : PubMed/NCBI
8	Farid H, Lau TC, Karmon AE and Styer AK: Clinical characteristics associated with antibiotic treatment failure for tuboovarian abscesses. Infect Dis Obstet Gynecol. 2016:51202932016. View Article : Google Scholar : PubMed/NCBI
9	Topcu HO, Kokanali K, Güzel AI, Tokmak A, Erkılınç S, Ümit C and Doğanay M: Risk factors for adverse clinical outcomes in patients with tubo-ovarian abscess. J Obstet Gynaecol. 35:699–702. 2015. View Article : Google Scholar : PubMed/NCBI
10	Akkurt MÖ, Yalcin SE, Akkurt I, Tatar B, Yavuz A, Yalçın Y, Akgül MA and Kayıkçıoğlu F: The evaluation of risk factors for failed response to conservative treatment in tubo-ovarian abscesses. J Turk Ger Gynecol Assoc. 16:226–230. 2015. View Article : Google Scholar : PubMed/NCBI
11	Silva F, Castro J, Godinho C, Gonçalves J, Ramalho G and Valente F: Minimally invasive approach of tubo-ovarian abscesses. Rev Bras Ginecol Obstet. 37:115–118. 2015. View Article : Google Scholar : PubMed/NCBI
12	Brun JL, Graesslin O, Fauconnier A, Verdon R, Agostini A, Bourret A, Derniaux E, Garbin O, Huchon C, Lamy C, et al: Updated French guidelines for diagnosis and management of pelvic inflammatory disease. Int J Gynaecol Obstet. 134:121–125. 2016. View Article : Google Scholar : PubMed/NCBI
13	Workowski K and Bolan G; Centers for Disease Control and Prevention, : Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 64:1–137. 2015.PubMed/NCBI
14	Chu L, Ma H, Liang J, Li L, Shen A, Wang J, Li H and Tong X: Effectiveness and adverse events of early laparoscopic therapy versus conservative treatment for tubo-ovarian or pelvic abscess: A single-center retrospective cohort study. Gynecol Obstet Invest. 1–9. Jan 4–2019.(Epub ahead of print).
15	Henry-Suchet J, Soler A and Loffredo V: Laparoscopic treatment of tuboovarian abscesses. J Reprod Med. 29:579–582. 1984.PubMed/NCBI
16	Granberg S, Gjelland K and Ekerhovd E: The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol. 23:667–678. 2009. View Article : Google Scholar : PubMed/NCBI
17	Jaiyeoba O, Lazenby G and Soper D: Recommendations and rationale for the treatment of pelvic inflammatory disease. Expert Rev Anti Infect Ther. 9:61–70. 2011. View Article : Google Scholar : PubMed/NCBI
18	Wiesenfeld HC and Sweet RL: Progress in the management of tuboovarian abscesses. Clin Obstet Gynecol. 36:433–444. 1993. View Article : Google Scholar : PubMed/NCBI
19	Bevan CD, Johal BJ, Mumtaz G, Ridgway GL and Siddle NC: Clinical, laparoscopic and microbiological findings in acute salpingitis: Report on a United Kingdom cohort. Br J Obstet Gynaecol. 102:407–414. 1995. View Article : Google Scholar : PubMed/NCBI
20	Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, et al: Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease. Am J Obstet Gynecol. 184:856–864. 2001. View Article : Google Scholar : PubMed/NCBI
21	Gaitán H, Angel E, Diaz R, Parada A, Sanchez L and Vargas C: Accuracy of five different diagnostic techniques in mild-to-moderate pelvic inflammatory disease. Infect Dis Obstet Gynecol. 10:171–180. 2002. View Article : Google Scholar : PubMed/NCBI
22	Roberts W and Dockery JL: Operative and conservative treatment of tubo-ovarian abscess due to pelvic inflammatory disease. South Med J. 77:860–863. 1984. View Article : Google Scholar : PubMed/NCBI
23	Dewitt J, Reining A, Allsworth JE and Peipert JF: Tuboovarian abscesses: Is size associated with duration of hospitalization & complications? Obstet Gynecol Int. 2010:8470412010. View Article : Google Scholar : PubMed/NCBI
24	Kinay T, Unlubilgin E, Cirik DA, Kayikcioglu F, Akgul MA and Dolen I: The value of ultrasonographic tubo-ovarian abscess morphology in predicting whether patients will require surgical treatment. Int J Gynaecol Obstet. 135:77–81. 2016. View Article : Google Scholar : PubMed/NCBI
25	Güngördük K, Guzel E, Asicioğlu O, Yildirim G, Ataser G, Ark C, Gulova SS and Uzuncakmak C: Experience of tubo-ovarian abscess in western Turkey. Int J Gynaecol Obstet. 124:45–50. 2014. View Article : Google Scholar : PubMed/NCBI
26	Chappell CA and Wiesenfeld HC: Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol. 55:893–903. 2012. View Article : Google Scholar : PubMed/NCBI
27	Mizushima T, Yoshida H, Ohi Y, Ishikawa M and Hirahara F: Evaluating the risk factors for developing resistance to parenteral therapy for tubo-ovarian abscess: A case-control study. J Obstet Gynaecol Res. 39:1019–1023. 2013. View Article : Google Scholar : PubMed/NCBI
28	Workowski KA and Berman S; Centers for Disease Control and Prevention (CDC), : Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 59:1–110. 2010.PubMed/NCBI
29	Protopapas AG, Diakomanolis ES, Milingos SD, Rodolakis AJ, Markaki SN, Vlachos GD, Papadopoulos DE and Michalas SP: Tubo-ovarian abscesses in postmenopausal women: Gynecological malignancy until proven otherwise? Eur J Obstet Gynecol Reprod Biol. 114:203–209. 2004. View Article : Google Scholar : PubMed/NCBI
30	Gjelland K, Ekerhovd E and Granberg S: Transvaginal ultrasound-guided aspiration for treatment of tubo-ovarian abscess: A study of 302 cases. Am J Obstet Gynecol. 193:1323–1330. 2005. View Article : Google Scholar : PubMed/NCBI
31	Greenstein Y, Shah AJ, Vragovic O, Cabral H, Soto-Wright V, Borgatta L and Kuohung W: Tuboovarian abscess. Factors associated with operative intervention after failed antibiotic therapy. J Reprod Med. 58:101–106. 2013.PubMed/NCBI
32	Halperin R, Levinson O, Yaron M, Bukovsky I and Schneider D: Tubo-ovarian abscess in older women: Is the woman's age a risk factor for failed response to conservative treatment? Gynecol Obstet Invest. 55:211–215. 2003. View Article : Google Scholar : PubMed/NCBI
33	Liu YT, Shi HH, Yu X, Wang S, Fan QB and Liu HY: Clinical analysis of pelvic abscess with endometriosis. Zhonghua Fu Chan Ke Za Zhi. 52:164–167. 2017.(In Chinese). PubMed/NCBI
34	Villette C, Bourret A, Santulli P, Gayet V, Chapron C and de Ziegler D: Risks of tubo-ovarian abscess in cases of endometrioma and assisted reproductive technologies are both under- and overreported. Fertil Steril. 106:410–415. 2016. View Article : Google Scholar : PubMed/NCBI
35	Landers DV and Sweet RL: Tubo-ovarian abscess: Contemporary approach to management. Rev Infect Dis. 5:876–884. 1983. View Article : Google Scholar : PubMed/NCBI
36	Hiller N, Fux T, Finkelstein A, Mezeh H and Simanovsky N: CT differentiation between tubo-ovarian and appendiceal origin of right lower quadrant abscess: CT, clinical, and laboratory correlation. Emerg Radiol. 23:133–139. 2016. View Article : Google Scholar : PubMed/NCBI
37	van der Voort M, Heijnsdijk EA and Gouma DJ: Bowel injury as a complication of laparoscopy. Br J Surg. 91:1253–1258. 2004. View Article : Google Scholar : PubMed/NCBI
38	Ghonge NP and Ghonge SD: Computed tomography and magnetic resonance imaging in the evaluation of pelvic peritoneal adhesions: What radiologists need to know? Indian J Radiol Imaging. 24:149–155. 2014. View Article : Google Scholar : PubMed/NCBI