Laparoscopic management of adnexal abscesses: consequences for fertility

Abstract

Objective: To study fertility of patients with adnexal abscesses treated by laparoscopy, antibiotic therapy, and second-look laparoscopy.

Design: A retrospective clinical study.

Setting: Department of Obstetrics Gynecology and Reproductive Medicine, University of Auvergne, University Hospital of Clermont Ferrand, France.

Patient(s): Thirty-nine patients treated for adnexal abscesses between January 1983 and December 1992.

Intervention(s): Laparoscopic drainage of adnexal abscesses was performed in all patients; 35 patients underwent a second laparoscopy 3 to 6 months later.

Main outcome measure(s): Immediate and long-term clinical results, anatomical data obtained at second-look laparoscopy, spontaneous fertility.

Result(s): No immediate reoperation was necessary within the first 2 months after the initial laparoscopic surgery. At second-look laparoscopy, an adhesiolysis was necessary in all cases. A distal tuboplasty was performed in 17 patients and 6 patients were referred to IVF-ET. Subsequently, 12 of 19 patients not using any contraception obtained a spontaneous intrauterine pregnancy (63%).

Conclusion(s): This study confirms that laparoscopic surgery is a safe and efficient technique for treating adnexal abscesses. Anatomical results observed at second-look laparoscopy suggest that this second surgical step is essential for patients desiring future pregnancy.