ObjectiveCan the patient’s intraoperative and postoperative safety be improved using operative laparoscopy with sole incision of the abscess cavity and lavage (organ-preserving treatment) compared with laparoscopic salpingectomy or salpingo-oophorectomy (ablative treatment)?MethodsFrom 1994 to 1999 the authors performed a retrospective chart review of 68 patients with tubo-ovarian abscess (TOA) undergoing laparoscopic treatment in combination with broad-spectrum antibiotics. Patients not wishing to remain fertile underwent salpingectomy or salpingo-oophorectomy whereas patients wishing to remain fertile were treated by means of an organ-preserving procedure.ResultsThirty of 68 women with TOA were treated laparoscopically preserving the internal genital organs. Thirty-eight patients received ablative treatment. In the organ-preserving group there were no operative complications or serious systemic sequelae apart from two postoperative re-admissions for pelvic pain. With ablative treatment, however, the authors found a significantly higher incidence of intraoperative and postoperative complications.ConclusionWhen laparoscopic treatment of TOA is performed, organ-preserving treatment should be preferred in order to reduce the risk of complications. This choice should be made irrespective of the patient’s age or desire to remain fertile.