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Benefits of second-look laparoscopy in the management of pelvic inflammatory disease
Anne Sophie Gremeau1, Anais Girard1, Celine Lambert2
1Department of Gynecology, University Hospital, Clermont-Ferrand, France.
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.
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