Operative laparoscopy versus trans-vaginal ultrasound-guided aspiration in the management of acute tubo-ovarian abscess a comparative clinical trial

ABSTRACT

The purpose of this study was to evaluate the effectiveness of two invasive procedures in the management of acute tubo-ovarian abscesses for women who need preservation of their fertility. The study population consisted of 27 women presented as acute pelvic inflammatory disease with the development of tubo- ovarian abscess. The diagnosis was verified by clinical picture, laboratory investigations [leukocytic count and C reactive protein] and imaging techniques [transvaginal ultrasound and CT]. Twelve women were subjected to transvaginal ultrasound-guided aspiration of the tubo-ovarian abscess [group A], while the other 15 women underwent operative laparoscopy [group B]. Systemic and local antibiotics were administrated in both groups. Second look laparoscopy was performed to 10 women in group A and 11 women in group B 3 to 6 months after the initial procedure. The results showed that both techniques were successful in the treatment of acute tubo-ovarian abscesses with nearly equal results as regard drainage of the pus, response to antimicrobial therapy and clinical response [drop in temperature, relief of pain and hospital stay]. No complications were reported in both groups. The second look laparoscopy after three months showed that the incidence of extensive adhesions with bilateral tuba1 block was significantly higher in group A than in group B