Pelvic abscesses: pelviscopy or laparotomy
Mecke, H.; Semm, K.; Freys, I.; Gent, H.J.
Gynecologic and Obstetric Investigation 31(4): 231-234
1991
ISSN/ISBN: 0378-7346 PMID: 1832133 DOI: 10.1159/000293165Document Number: 316243
Physicians at Christian Albrecht University Hospital in Keil, West Germany treated 66 women with pelvic abscesses between 1983-1986. Pelviscopically treated patients were younger than laparotomy treated patients and IUD usage occurred 17% vs. 20% respectively. They 1st treated many patients with ampicillin and metronidazole or ampicillin and clavulanic acid. They were able to perform pelviscopy on 25 of the 33 patients with inflamed Fallopian tubes. 9 of these women experienced either a uni- or bilateral salpingectomy or salpingo-oophorectomy. They were able to do an organ preserving procedure designed to preserve fertility in 80% of the women, especially pelviscopically treated patients (81% vs. 16% laparotomy patients). They performed a laparotomy on the 6 patients with bilateral total abdominal tuboovarian abscesses. Of the 25 women who underwent a laparotomy, 20 required only a uni- or bilateral salpingectomy or salpingo-oophorectomy and 5 required a total hysterectomy and bilateral salpingectomy. No differences existed between pelviscopically and laparotomy patients in number of days in the hospital and duration of inpatient antibiotic therapy. Even though more laparotomy treated patients (37%) experienced chronic abdominal pain following treatment than pelviscopically treated patients (27%), the laparotomy patients initially experienced more severe and extensive infections than did pelviscopically treated patients. Of the 45 patients who were able to be examined 1-2 years after surgery, only 3 experienced recurrent pelvic inflammatory disease (8% of pelviscopically treated patients and 5% of laparotomy patients) which the physicians found encouraging since pregnancies may occur. In conclusion, to preserve fertility, they advocated pelviscopy along with organ preservation for patients in their reproductive years.