54: Laparoscopic management of tubo-ovarian abscesses

Abstract

The objective of this video is to discuss principles of laparoscopic surgical management of intraperitoneal abscess. In doing so we will review application of basic surgical technique in complex surgical cases. Tubo-ovarian abscesses affect an estimated 66,000 women per year in the United States. While it is an uncommon diagnosis it can lead to significant morbidity and potential mortality for those affected. Standard therapy consists of hospitalization, intravenous antibiotics and not infrequently placement of intraperitoneal drain(s) by radiology. When these conservative measure fail, surgical intervention is necessary. A minimally invasive approach can be daunting in the setting of a diffusely infected pelvis and potential adhesive disease. However, laparoscopy offers several advantages to laparotomy for patients with pelvic abscesses; most notably shorter recovery time and decreased postoperative wound infections. The majority of surgical time is spent in lysing adhesions, both dense and filmy. A variety of techniques are demonstrated using blunt and sharp instruments. Normalization of anatomy is key to assessing if additional procedures are necessary. Abdominal washout and abscess irrigation is often all that is needed to achieve clinical improvement. Adnexectomy is not often required and hysterectomy is rarely needed. Judicious resection of pelvic structures is recommended as removal may lead to further complications and infections. The use of common laparoscopic instruments, basic surgical techniques, abdominal washout and proficient knowledge of intra-abdominal anatomy can safely expedite the recovery of these women.