Drainage of Tubo - Ovarian Abscess: DTOA

NCT ID: NCT03166982

Last Updated: 2017-05-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-10-26

Study Completion Date

2018-12-31

Brief Summary

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The treatment of the acute phase of the complicated abscess tubo-ovarian relies on antibiotics more or less associated with surgical management in case of visible abscess, poor clinical tolerance (sepsis) and resistance to medical treatment. The CNGOF recommended in 2012 that the tubo-ovarian abscess are not within one antibiotic, and should be drained by interventional radiology, preferably by transvaginal or laparoscopic.

Furthermore the efficiency of drainage by ultrasound puncture performed vaginally was demonstrated. This approach tends to replace the first laparoscopy because of its less invasive, fast, easy to access, more acceptable and less cost compared to laparoscopy. This approach is recommended by the French and English colleges.

In total, the surgery in case of ATO is necessary, it is always coupled with antibiotics. Several surgical approaches are possible, laparotomy, laparoscopy and ultrasound-guided puncture. No prospective comparative study has been done, for which we want to develop this study.

Detailed Description

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Retrospective studies evaluating the efficacy of these two supported relate the same cure rates between the two techniques. According to the literature of Garbin O.and al in 2012, the success rate of transvaginal puncture is generally 93.6%. The largest series of Gjelland al in 2005 and covers 302 consecutive patients with ATO who underwent triple antibiotic therapy and transvaginal puncture, the success rate was 93.4%. The failures that required surgical management have frequently revealed endometriosis or cancer. To support laparoscopic, Raiga and al in 1996 studied the support of 36 retrospectively patients who underwent laparoscopic incisional and wash the abscess with a success rate of 100%. Moreover Reich and al in 1987 found 90% success on a review of 25 patients.

The transvaginal echo guided puncture to replace the first laparoscopy because of its less invasive nature, this is a simple act, fast, possible under mild sedation, the cost is still lower than laparoscopy. Some uncontrolled retrospective studies suggest that laparoscopy remains associated with prolongation of hospitalization time, it is also mentioned that the transvaginal puncture is better tolerated by the patient.

No study has compared these two techniques, which is why we propose this study.

Conditions

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Tubo-ovarian Abscess

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants receive an intervention throughout the protocol
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Open

Study Groups

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laparoscopy

the tubo-ovarian abscess should be drained by interventional radiology, preferably by transvaginal or laparoscopic

Group Type EXPERIMENTAL

laparoscopic approach

Intervention Type PROCEDURE

ultrasound-guided puncture

The transvaginal echo guided puncture to replace the first laparoscopy because of its less invasive nature, this is a simple act, fast, possible under mild sedation, the cost is still lower than laparoscopy

Group Type EXPERIMENTAL

transvaginal approach

Intervention Type PROCEDURE

Interventions

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transvaginal approach

Intervention Type PROCEDURE

laparoscopic approach

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients with a IGH with tubo-ovarian abscess visible on ultrasound or CT
* Ultrasound abscess\> or equal to 2cm
* Abdominal pain syndrome
* Age 18 to 43 years
* understand french language
* No complicated: good hemodynamic tolerance, not broken
* These patients should be affiliated to the French Social Security and must have given informed participation agreement

Exclusion Criteria

Patients with HIV (CD4 \<200) or co-infections: immunosuppression

* Multi-Abdomen surgery
* Suspected malignant or borderline tumor
* Complicated abscess: rupture of the abscess, peritonitis, septic shock
* Postoperative pelvic abscess
* Patient minor
* During Pregnancy
* Patient having already been accounted for tubo-ovarian abscess in progress
* Not accessible abscess transvaginal puncture
* Patients unable major, patients suffering from mental pathology incompatible with informed consent, refusal to participate
Minimum Eligible Age

18 Years

Maximum Eligible Age

43 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Clermont-Ferrand

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Anne-Sophie GREMEAU

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Clermont-Ferrand

Locations

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CHU Clermont-Ferrand

Clermont-Ferrand, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Patrick LACARIN

Role: CONTACT

04 73 75 15 95

Facility Contacts

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Patrick LACARIN

Role: primary

04 73 75 11 95

References

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Gjelland K, Ekerhovd E, Granberg S. Transvaginal ultrasound-guided aspiration for treatment of tubo-ovarian abscess: a study of 302 cases. Am J Obstet Gynecol. 2005 Oct;193(4):1323-30. doi: 10.1016/j.ajog.2005.06.019.

Reference Type BACKGROUND
PMID: 16202721 (View on PubMed)

Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol. 2009 Oct;23(5):667-78. doi: 10.1016/j.bpobgyn.2009.01.010. Epub 2009 Feb 20.

Reference Type BACKGROUND
PMID: 19230781 (View on PubMed)

Gerber B, Krause A. A study of second-look laparoscopy after acute salpingitis. Arch Gynecol Obstet. 1996;258(4):193-200. doi: 10.1007/s004040050123.

Reference Type BACKGROUND
PMID: 8844136 (View on PubMed)

Le Bouedec G, Pouly JL, Canis M, Wattiez A, Abbas B, Mage G, Bruhat MA. [Acute salpingitis. Celioscopy before and after treatment: 110 cases]. J Gynecol Obstet Biol Reprod (Paris). 1991;20(5):680-4. French.

Reference Type BACKGROUND
PMID: 1835469 (View on PubMed)

Raiga J, Canis M, Le Bouedec G, Glowaczower E, Pouly JL, Mage G, Bruhat MA. Laparoscopic management of adnexal abscesses: consequences for fertility. Fertil Steril. 1996 Nov;66(5):712-7. doi: 10.1016/s0015-0282(16)58623-3.

Reference Type BACKGROUND
PMID: 8893672 (View on PubMed)

Heinonen PK, Leinonen M. Fecundity and morbidity following acute pelvic inflammatory disease treated with doxycycline and metronidazole. Arch Gynecol Obstet. 2003 Oct;268(4):284-8. doi: 10.1007/s00404-002-0376-6. Epub 2002 Oct 26.

Reference Type BACKGROUND
PMID: 14504870 (View on PubMed)

Trent M, Bass D, Ness RB, Haggerty C. Recurrent PID, subsequent STI, and reproductive health outcomes: findings from the PID evaluation and clinical health (PEACH) study. Sex Transm Dis. 2011 Sep;38(9):879-81. doi: 10.1097/OLQ.0b013e31821f918c.

Reference Type BACKGROUND
PMID: 21844746 (View on PubMed)

Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Songer T, Lave JR, Hillier SL, Bass DC, Kelsey SF. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol. 2002 May;186(5):929-37. doi: 10.1067/mob.2002.121625.

Reference Type BACKGROUND
PMID: 12015517 (View on PubMed)

Abbitt PL, Goldwag S, Urbanski S. Endovaginal sonography for guidance in draining pelvic fluid collections. AJR Am J Roentgenol. 1990 Apr;154(4):849-50. doi: 10.2214/ajr.154.4.2107687. No abstract available.

Reference Type BACKGROUND
PMID: 2107687 (View on PubMed)

Buchweitz O, Malik E, Kressin P, Meyhoefer-Malik A, Diedrich K. Laparoscopic management of tubo-ovarian abscesses: retrospective analysis of 60 cases. Surg Endosc. 2000 Oct;14(10):948-50. doi: 10.1007/s004640000249.

Reference Type BACKGROUND
PMID: 11080409 (View on PubMed)

Henry-Suchet J, Soler A, Loffredo V. Laparoscopic treatment of tuboovarian abscesses. J Reprod Med. 1984 Aug;29(8):579-82. No abstract available.

Reference Type BACKGROUND
PMID: 6237196 (View on PubMed)

Garbin O, Verdon R, Fauconnier A. [Treatment of the tubo-ovarian abscesses]. J Gynecol Obstet Biol Reprod (Paris). 2012 Dec;41(8):875-85. doi: 10.1016/j.jgyn.2012.09.012. Epub 2012 Nov 10. French.

Reference Type BACKGROUND
PMID: 23146745 (View on PubMed)

Perez-Medina T, Huertas MA, Bajo JM. Early ultrasound-guided transvaginal drainage of tubo-ovarian abscesses: a randomized study. Ultrasound Obstet Gynecol. 1996 Jun;7(6):435-8. doi: 10.1046/j.1469-0705.1996.07060435.x.

Reference Type BACKGROUND
PMID: 8807761 (View on PubMed)

Vermersch C, Dessein R, Lucot JP, Rubod C, Cosson M, Giraudet G. [Tubo-ovarian abscesses treatment: Faisability and results of trans-vaginal ultrasound-guided aspiration]. J Gynecol Obstet Biol Reprod (Paris). 2016 Mar;45(3):243-8. doi: 10.1016/j.jgyn.2015.04.016. Epub 2015 Jun 19. French.

Reference Type BACKGROUND
PMID: 26096351 (View on PubMed)

Other Identifiers

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2016-A00961-50

Identifier Type: OTHER

Identifier Source: secondary_id

CHU-0283

Identifier Type: -

Identifier Source: org_study_id

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