Benefits of second-look laparoscopy in the management of pelvic inflammatory disease

To evaluate the benefits of second-look laparoscopy (SLL) in pelvic inflammatory disease (PID). A 5- year retrospective study conducted at Clermont-Ferrand University Hospital and included all patients who had undergone SLL following a PID. Data collection comprised patient and disease characteristi...

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Published in:Journal of gynecology obstetrics and human reproduction 2019-06, Vol.48 (6), p.413-417
Main Authors: Gremeau, Anne Sophie, Girard, Anais, Lambert, Celine, Chauvet, Pauline, Bourdel, Nicolas, Canis, Michel, Pouly, Jean Luc
Format: Article
Language:English
Subjects:
Adult
Anti-Bacterial Agents - therapeutic use
Bacterial Infections - complications
Bacterial Infections - drug therapy
Female
Fertility
Fertility Preservation
France
Humans
Laparoscopy
Life Sciences
Pelvic inflammatory disease
Pelvic Inflammatory Disease - diagnosis
Pelvic Inflammatory Disease - etiology
Pelvic Inflammatory Disease - therapy
Pelvic Pain
Pregnancy
Retrospective Studies
Salpingitis - microbiology
Salpingitis - therapy
Second look laparoscopy
Second-Look Surgery
Tissue Adhesions - complications
Tissue Adhesions - therapy
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Summary:To evaluate the benefits of second-look laparoscopy (SLL) in pelvic inflammatory disease (PID). A 5- year retrospective study conducted at Clermont-Ferrand University Hospital and included all patients who had undergone SLL following a PID. Data collection comprised patient and disease characteristics, type of initial medical or surgical treatment, adhesion (AFS) and tubal (MAGE) scores recorded during SLL and outcomes following subsequent pregnancies. 76 patients who had received SLL were included. A higher rate of severe adhesions was recorded during SLL in patients with stage 3 PID, than for women with stage 1 and 2 (63.6% versus 25%, p = 0.01). A higher rate of Mage scores of 4 were also found in patients with stage 3 PID (25.8% versus 0%, p = 0.001). Multivariate analysis revealed that women at stage 3 are 17 times more likely to have a high level of adhesions than patients at stage 1 (OR [95% CI] = 17.4 [1.7; 1]). A Mage score of 1was found to be associated with higher pregnancy and live birth rates. SLL seems presents benefits for the preservation of fertility in cases of severe PID with tubo ovarian abcess and may be proposed to patients with stage 3 salpingitis and desire for pregnancy. Further prospective randomized study should be done to confirm these results.
ISSN:2468-7847
2468-8495
2468-7847
DOI:10.1016/j.jogoh.2019.03.020