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

Goje, Oluwatosin; Markwei, Metabel; Kollikonda, Swapna; Chavan, Monica; Soper, David E

OBJECTIVE To compare the success rate, complications, and hospital length-of-stay (LOS) of three modalities of minimally invasive management of tubo-ovarian abscesses (TOA): laparoscopy, ultrasound-guided drainage and computerized tomography (CT)-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 (MeSH) 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. RESULTS A total of 975 patients were included in our study; 107 (11%) had laparoscopic drainage procedures, and 406 (42%) had image-guided (US or CT) drainage of TOA. Image-guided TOA drainage had higher success rates (90 - 100%), when compared with 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 to 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 via minimally invasive approach compared to conservative treatment with antibiotics only. Of the minimally invasive techniques, image-guided drainage of TOAs provided the highest success rates, lowest complications, and the shortest hospital stays compared to laparoscopy. The low magnitude of evidence in the included studies, calls for further randomized trials. REVIEW This systematic review was registered in the International Prospective Register of Systematic Review (PROSPERO register, http://www.crd.york.ac.uk/PROSPERO;CRD 42020170345).