Ambulatory management of selected tubo-ovarian abscesses using transvaginal ultrasound-guided drainage: a pilot observational study

Tubo-ovarian abscesses (TOA) larger than 3–4 cm require drainage, usually by laparoscopy under general anaesthesia during conventional hospitalization. Transvaginal ultrasound-guided aspiration is less invasive, but has not been evaluated in an outpatient setting with local anaesthesia and predominantly oral antibiotics. We aimed to assess the feasibility of this ambulatory strategy in women with TOA without criteria requiring hospitalization. We conducted a single-centre observational pilot study in a French tertiary university hospital. Twenty-eight women were analysed: five underwent ambulatory transvaginal ultrasound-guided drainage under local anaesthesia with minimal sedation, followed by predominantly oral antibiotic therapy (July 2022 to August 2023), and 23 underwent laparoscopic drainage during conventional hospitalization (2016 to 2018). The prespecified primary outcome was treatment success at one month, a composite of apyrexia (< 38.0 °C), absence of reintervention for pelvic collection and absence of second-line, prolonged or reintroduced antibiotic therapy. Secondary outcomes included discharge within 24 h, residual mass, symptom resolution, complications and quality of life. All between-group comparisons are descriptive. No woman in the ambulatory cohort was lost to follow-up. The primary outcome was met in 5/5 women in the ambulatory cohort (100%; 95% CI 47.8–100) and 23/23 in the comparator cohort (100%; 95% CI 85.2–100); both proportions incorporate the assumption that the 2/5 and 6/23 women without a documented Day 30 temperature were apyrexial. No procedure was converted to laparoscopy, and four of the five women were discharged the same day. Absence of a residual mass ≥ 3 cm was documented in 4/5 and 10/23 women (4/4 and 10/10 among those imaged). No complication was recorded, although with five exposed women uncommon complications cannot be detected. Patient-reported outcomes, available for an incomplete subset, are reported descriptively. In this pilot experience, five carefully selected women with tubo-ovarian abscess completed an ambulatory pathway combining transvaginal ultrasound-guided drainage under local anaesthesia with predominantly oral antibiotic therapy. These observations cannot establish feasibility, efficacy or safety, nor support comparison with inpatient laparoscopic management. Adequately powered prospective studies are needed. ClinicalTrials.gov, NCT05408624. Registered 7 June 2022 (submitted 23 May 2022), before enrolment began on 15 July 2022.