Comparison of Early Clinical Efficacy of Transvaginal and Laparoscopic Drainage of Tubo-Ovarian Abscesses. Prospective Randomized Trial of Noninferiority.

OBJECTIVE

We aimed to evaluate the noninferiority of ultrasound-guided transvaginal puncture compared with laparoscopic drainage in the treatment of tubo-ovarian abscesses (TOA).

DESIGN

We conducted a prospective, randomized, two-arm, parallel, noninferiority, uni-centric, therapeutic trial comparing 2 surgical techniques for the management of TOA: echo-guided transvaginal puncture and laparoscopic drainage.

SUBJECTS: Subjects were patients aged 18 to 43 years with a tubo-ovarian abscess visible on ultrasound or CT scan, larger than 2 cm, without signs of complications. The per-protocol analysis, as recommended for noninferiority trials, included 38 patients.

INTERVENTION: Ultrasound-guided transvaginal puncture and laparoscopic drainage in the treatment of TOA.

MAIN OUTCOMES MEASURES: The main outcome was the rate of cure measured by a composite score: clinical improvement (pain and temperature) and biological improvement (regression of biological inflammatory syndrome). The secondary endpoints take into account various aspects of the early and late postoperative period.

RESULTS

Transvaginal puncture under ultrasound is no less effective than laparoscopy in the treatment of TOA associated with IV antibiotic therapy. It also showed that transvaginal puncture had the advantage of reducing the operating time and morphine consumption during hospitalization. No difference was observed between the two techniques on the 1-month follow-up ultrasound.

CONCLUSION

The best treatment for a tubo-ovarian abscess should be that which is the safest, most effective, least invasive, least expensive, and least detrimental to female fertility. Transvaginal puncture seems to meet these criteria; thanks to the DATO (Drainage of Tubo-Ovarian Abscesses) study, we were able to show that this procedure was no less effective than laparoscopy in terms of early cure.