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Endometriosis is a risk factor for recurrent pelvic inflammatory disease after tubo-ovarian abscess surgery

  • General Gynecology
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the clinical outcomes and prognosis of patients undergoing laparoscopic surgery for tubo-ovarian abscess (TOA) and identify risk factors for pelvic inflammatory disease (PID) recurrence.

Methods

We conducted a retrospective cohort analysis including 98 women who underwent laparoscopic surgery for TOA at the Department of Obstetrics and Gynecology at the Bern University Hospital from January 2011 to May 2021. The primary outcome studied was the recurrence of PID after TOA surgery. Clinical, laboratory, imaging, and surgical outcomes were examined as possible risk factors for PID recurrence.

Results

Out of the 98 patients included in the study, 21 (21.4%) presented at least one PID recurrence after surgery. In the univariate regression analysis, the presence of endometriosis, ovarian endometrioma, and the isolation of E. coli in the microbiology cultures correlated with PID recurrence. However, only endometriosis was identified as an independent risk factor in the multivariate analysis (OR (95% CI): 9.62 (1.931, 47.924), p < 0.01). With regard to the time of recurrence after surgery, two distinct recurrence clusters were observed. All patients with early recurrence (≤ 45 days after TOA surgery) were cured after 1 or 2 additional interventions, whereas 40% of the patients with late recurrence (> 45 days after TOA surgery) required 3 or more additional interventions until cured.

Conclusion

Endometriosis is a significant risk factor for PID recurrence after TOA surgery. Optimized therapeutic strategies such as closer postsurgical follow-up as well as longer antibiotic and hormonal therapy should be assessed in further studies in this specific patient population.

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Acknowledgements

We would like to thank all participants in our study.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Author notes

  1. Maria Zografou Themeli and Konstantinos Nirgianakis have equal contributions.

Authors and Affiliations

  1. Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Friedbuehlstrasse 19, 3010, Bern, Switzerland

    Maria Zografou Themeli, Konstantinos Nirgianakis, Stephanie Neumann, Sara Imboden & M. D. Mueller

Authors
  1. Maria Zografou Themeli
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  2. Konstantinos Nirgianakis
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  3. Stephanie Neumann
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  4. Sara Imboden
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Contributions

ZTM: protocol and project development, data collection and management, data analysis, manuscript writing and editing. NK: protocol and project development, manuscript writing and editing. NS: data collection and management. IS: manuscript writing and editing. MMD: protocol and project development, manuscript writing and editing.

Corresponding author

Correspondence to Maria Zografou Themeli.

Ethics declarations

Conflict of interest

Authors A, B, and C declare they have no financial interests. Author D has received speaker honoraria from Company Bayer. Author E has received a research grant from Inno Suisse Foundation and speaker honoraria from Companies Bayer, Roche, and Storz.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. The ethical approval was granted by the Ethics Committee of Switzerland, the IRB (Institutional Review Board for research ethics, Bern) and was registered with the number 2021-01194.

Informed consent

Due to the retrospective design of the study no informed consent was obtained.

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Zografou Themeli, M., Nirgianakis, K., Neumann, S. et al. Endometriosis is a risk factor for recurrent pelvic inflammatory disease after tubo-ovarian abscess surgery. Arch Gynecol Obstet 307, 139–148 (2023). https://doi.org/10.1007/s00404-022-06743-6

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