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Outcomes of Minimally Invasive Management of Tubo-ovarian Abscess: A Systematic Review.
J Minim Invasive Gynecol. 2021 Mar; 28(3):556-564.JM

Abstract

OBJECTIVE

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. Image-guided 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).

Authors+Show Affiliations

Obstetrics & Gynecology and Women's Health Institute, Cleveland Clinic Foundation (Drs. Goje and Kollikonda). Electronic address: gojeo@ccf.org.Cleveland Clinic Lerner College of Medicine, Case Western Reserve University (Ms. Markwei).Obstetrics & Gynecology and Women's Health Institute, Cleveland Clinic Foundation (Drs. Goje and Kollikonda).Case Western Reserve University School of Medicine (Ms. Chavan), Cleveland, Ohio.Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina (Dr. Soper).

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32992023

Citation

Goje, Oluwatosin, et al. "Outcomes of Minimally Invasive Management of Tubo-ovarian Abscess: a Systematic Review." Journal of Minimally Invasive Gynecology, vol. 28, no. 3, 2021, pp. 556-564.
Goje O, Markwei M, Kollikonda S, et al. Outcomes of Minimally Invasive Management of Tubo-ovarian Abscess: A Systematic Review. J Minim Invasive Gynecol. 2021;28(3):556-564.
Goje, O., Markwei, M., Kollikonda, S., Chavan, M., & Soper, D. E. (2021). Outcomes of Minimally Invasive Management of Tubo-ovarian Abscess: A Systematic Review. Journal of Minimally Invasive Gynecology, 28(3), 556-564. https://doi.org/10.1016/j.jmig.2020.09.014
Goje O, et al. Outcomes of Minimally Invasive Management of Tubo-ovarian Abscess: a Systematic Review. J Minim Invasive Gynecol. 2021;28(3):556-564. PubMed PMID: 32992023.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of Minimally Invasive Management of Tubo-ovarian Abscess: A Systematic Review. AU - Goje,Oluwatosin, AU - Markwei,Metabel, AU - Kollikonda,Swapna, AU - Chavan,Monica, AU - Soper,David E, Y1 - 2020/09/28/ PY - 2020/07/29/received PY - 2020/09/09/revised PY - 2020/09/19/accepted PY - 2020/9/30/pubmed PY - 2020/9/30/medline PY - 2020/9/29/entrez KW - Computed tomography KW - Drainage KW - Laparoscopy KW - Ultrasonography SP - 556 EP - 564 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 28 IS - 3 N2 - OBJECTIVE: 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. Image-guided 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). SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/32992023/Outcomes_of_Minimally_Invasive_Management_of_Tubo-ovarian_Abscess:_A_Systematic_Review. L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(20)31046-3 DB - PRIME DP - Unbound Medicine ER -
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