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#Grand Rounds

Laparoscopic Surgery or Laparotomy for Severe PID?

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BACKGROUND AND PURPOSE:

  • Shigemi et al. (Obstetrics & Gynecology, 2019) compared operative outcomes of laparoscopic surgery versus laparotomy in patients with moderate to severe PID and tubo-ovarian abscess (TOA)

METHODS:

  • Nationwide retrospective cohort study
  • Participants
    • ≥18 years diagnosed with PID and hospital admission
    • With or without TOA
    • Exclusion: Pregnancy | Malignancy | Missing relevant data
  • Exposures
    • Laparoscopic surgery
    • Laparotomy
  • Data analysis
    • Propensity score–matched analyses were performed to compare operative outcomes to adjust for confounders such as presence of TOA, choice of antibiotic, preexisting co-morbidities
    • Variables such as size of TOA, adhesions and surgeon’s skill could not be assessed
  • Primary outcomes
    • Length of stay
    • Surgical complications
    • In-hospital deaths
    • Revision surgery

RESULTS:

  • 27,841 patients with PID were included
    • Percutaneous drainage: 8.2%
    • Surgical intervention: 15.9%
    • 749 women underwent laparoscopy | 3,670 women underwent laparotomy
    • 740 pairs matched pairs were created

The laparoscopic group vs laparotomy group demonstrated improved outcomes for the following (all P<.001)

  • Operation duration
    • Laparoscopic: 125 min | Laparatomy: 166 min
  • Blood transfusion
    • Laparoscopic: 4.7% | Laparatomy: 10.0%
  • Length of stay (median)
    • Laparoscopic: 5 days | Laparatomy: 7 days
  • No significant differences for the following outcomes
    • In-hospital deaths | Surgical complications | Revision surgery

CONCLUSION:

  • The authors recognize limitations of the study, including retrospective design and absence of data following discharge
  • However, laparoscopic surgery did appear to confer benefit over laparotomy in patients with severe PID

Learn More – Primary Sources:

Laparoscopic Compared With Open Surgery for Severe Pelvic Inflammatory Disease and Tubo-Ovarian Abscess

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Pelvic Inflammatory Disease – CDC Treatment Guidelines
Is Laparoscopy Simulation Performance Correlated with Surgical Volume?
Intervention Comparison for the Treatment of Uterine Fibroids
Abdominal or Laparoscopic Hysterectomy for a Woman with an Enlarged Uterus?

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