Evaluation of Different Treatment Modalities for Tubo-Ovarian Abscess: Medical, Interventional, and Surgical Approaches

Background: Tubo-ovarian abscess (TOA) is a serious complication of pelvic inflammatory disease, and the optimal treatment approach remains uncertain. This study aimed to compare the effectiveness of medical, interventional, and surgical treatment modalities for tubo-ovarian abscess (TOA) and to evaluate their effects on clinical outcomes. Methods: A total of 62 patients diagnosed with TOA and treated at our clinic between April 2023 and April 2025 were retrospectively analyzed. Patients were divided into three groups according to treatment modality: medical therapy (n = 31), ultrasound-guided percutaneous drainage (n = 18), and surgical intervention (n = 13). Clinical findings, laboratory parameters, abscess size, antibiotic use, and length of hospital stay were compared among the groups. Results: The mean abscess size was 51.8 ± 18.1 mm in the medical group, 71.7 ± 30.3 mm in the interventional group, and 85.0 ± 31.4 mm in the surgical group, with a significant overall between-group difference (p = 0.001). Bonferroni-adjusted post hoc comparisons showed significant differences between the medical and interventional groups (p = 0.028) and between the medical and surgical groups (p = 0.002). The median length of hospital stay was shorter in the surgical group (6 days) than in the medical therapy group (7 days) and the interventional group (8 days) (p = 0.011). In multivariable Poisson regression analysis, higher admission C-reactive protein (CRP) levels were independently associated with a longer hospital stay (incidence rate ratio [IRR] = 1.001, 95% confidence interval [CI]: 1.000–1.002), whereas the ceftriaxone + metronidazole + doxycycline (DFM) antibiotic regimen was associated with a shorter hospital stay (IRR = 0.621, 95% CI: 0.516–0.747). Treatment modality was not independently associated with hospital stay after adjustment. Infection markers decreased significantly over time in all groups, while the magnitude of improvement did not differ significantly among treatment modalities. Conclusion: An individualized approach according to patient characteristics is essential in TOA management. In this cohort, surgical intervention was associated with shorter hospital stay despite larger abscess size, whereas ultrasound-guided drainage represented a minimally invasive alternative for selected patients. As the treatment allocation was not randomized, these findings should be interpreted with caution. Further prospective multicenter studies are required to establish optimal treatment algorithms.