Role of laparoscopy in the management of pelvic adhesions and pelvic sepsis.

Operative laparoscopy in pelvic sepsis is useful in acute cases: (a) for diagnosis, as there are 20-30% false positive and false negative diagnoses based on clinical and laboratory data alone; and (b) for treatment in severe cases and mainly in tubo-ovarian abscesses, laparoscopy allows aspiration of purulent discharge and, in recent cases, removal of fresh adhesions. In most cases, rapid and complete recovery is associated with treatment with an effective polyvalent antibiotic. Fertility is also preserved in most cases as assessed by a small series of bilateral abscesses with long-term follow-up. In CS associated with infertility, laparoscopic treatment is limited to velamentous adhesions or to dense adhesions of small extent. If performed after the completion of the inflammatory episode, laparoscopic surgery can give results comparable to those of microsurgery. A full bacteriological investigation and appropriate antibiotic treatment are necessary in order to stop or reduce the inflammatory condition which is usually associated with the development of adhesions and is a possible cause of their recurrence.