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J Gynecol Obstet Hum Reprod. 2019 Jun;48(6):413-417. doi: 10.1016/j.jogoh.2019.03.020. Epub 2019 Mar 22.

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

Author information

1
Department of Gynecology, University Hospital, Clermont-Ferrand, France. Electronic address: asgremeau@chu-clermontferrand.fr.
2
Department of Gynecology, University Hospital, Clermont-Ferrand, France.
3
Biostatistics Unit (DRCI), University Hospital, Clermont-Ferrand, France.

Abstract

OBJECTIVE:

To evaluate the benefits of second-look laparoscopy (SLL) in pelvic inflammatory disease (PID).

STUDY DESIGN:

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.

RESULTS:

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.

CONCLUSION(S):

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.

KEYWORDS:

Fertility; Pelvic inflammatory disease; Second look laparoscopy

PMID:
30910760
DOI:
10.1016/j.jogoh.2019.03.020
[Indexed for MEDLINE]

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