Video endoscopic technologies in treatment of pelvic inflammatory diseases

Aim: to access the efficacy and safety of antibacterial irrigation in the treatment of pelvic inflammatory disease (PID) using video endoscopic techniques.

Materials and Methods. A prospective comparative study was conducted. At the first stage, in the period from 2021 to 2023, 80 PID patients were treated, who underwent diagnostic laparoscopy to clarify the diagnosis. The patients were randomized into 2 groups: main group received parenteral antibacterial therapy in combination with local antibacterial therapy by delivering an antibiotic solution to the surgical site via microirrigator; comparison group received standard parenteral antibacterial therapy. During treatment, all patients were assessed for clinical and laboratory parameters of the inflammatory process: febrile period length and tachycardia recorded; severity of pain syndrome assessed using a visual analogue scale (VAS); level of C-reactive protein (CRP) measured; performed a clinical blood test with analyzing leukocyte formula; performed pelvic organs ultrasound examination. The second study stage was carried out in 2024–2025 by further outpatient monitoring of patients to assess long-term sequelae, as well as repeated exacerbations and pregnancy onset term consequences, as well as the presence of repeated exacerbations and the onset of pregnancy.

Results. On day 5 after diagnostic laparoscopy in main group, the CRP level and leukocytosis indicators normalized in 50,0 and 55,0 % patients, respectively; in comparison group, normalization of such indicators was observed in 27.5 % (p = 0.039) and 32.5 % (p = 0.043) cases, respectively. At discharge, white blood cell count and WBC differential were normal in 92.5 % and 75.0 % (p = 0.034) patients in main and comparison group, respectively. Febrile period length in main group was 2-fold shorter than in comparison group; duration of tachycardia remained unaffected. On day 5 after diagnostic laparoscopy, the level of pain syndrome in main group was smaller by 2-fold than in comparison group. At discharge, the patients from main group had a more favorable pelvic organs ultrasound picture showing a decreased number of patients in the former having increased ovarian volume to 12 ml, with hyperechoic areas, tubal thickening (p = 0.034), detected varying amounts of fluid in the pelvic area (p = 0.027), higher number of patients without pathology of the pelvic organs based on ultrasound data (p = 0.041). In patients who received combination treatment (main group), pregnancy occurred 2 times more often than in those treated solely with standard drug therapy (comparison group). In addition, normalized menstrual cycle was noted significantly more often (p = 0.007) in main group – 17 (42.5 %) vs. 6 (15.0 %) cases in comparison group. While assessing the development of complications and repeated exacerbations, no statistically significant inter-group differences were found.

Conclusion. The method we propose can be considered as an alternative treatment option for PID patients, who were referred to undergo diagnostic laparoscopy during differential diagnostics. Taking into consideration the lack of highquality randomized studies that would definitively confirm our results, it seems relevant to continue further investigation on this issue.

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