World Journal of Laparoscopic Surgery

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VOLUME 3 , ISSUE 3 ( September-December, 2010 ) > List of Articles

REVIEW ARTICLE

To Evaluate the Efficacy of Laparoscopic versus Open Surgical Management of the Tubal Pregnancy and its Effects on Future Pregnancy

Amardeep Bhimrao Tembhare

Citation Information : Tembhare AB. To Evaluate the Efficacy of Laparoscopic versus Open Surgical Management of the Tubal Pregnancy and its Effects on Future Pregnancy. World J Lap Surg 2010; 3 (3):153-158.

DOI: 10.5005/jp-journals-10007-1103

Published Online: 01-12-2010

Copyright Statement:  Copyright © 2010; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background

In the treatment of tubal ectopic pregnancy (EP), laparoscopic surgery remains the cornerstone of treatment (Cochrane Database 2007). In the absence of randomized data, the question as to whether surgical treatment should be performed either conservatively (salpingostomy) or radically (salpingectomy) in women with desire for future pregnancy is subject to ongoing debate (Mol et al 2008).

Since the first study demonstrated the potential effectiveness of salpingostomy, this treatment has been compared with salpingectomy in numerous nonrandomized studies (Stromme et al 1962, Mol et al 2008). Pooled data showed no beneficial effect of salpingostomy on intrauterine pregnancy (IUP) whereas there is an increased risk of repeat EP (Clausen 1996, Yao et al 1997, Mol et al 2008). Based on these findings, the Royal College of Obstetricians and Gynecologists guideline advises salpingectomy as the preferred standard surgical approach for tubal EP (RCOG 2004). However, there are good reasons to question this advice. Interpretation of the pooled data is troublesome, since many of the original studies failed to report essential details, e.g. time to pregnancy, presence of the desire for future pregnancy, and whether subsequent pregnancies occurred either spontaneously or after fertility treatment, such as in vitro fertilization (IVF). Only a few nonrandomized studies have taken these matters into account and came to different conclusions (Silva et al 1993, Job spira et al 1996, Mol et al 1998, Bouyer et al 2000, Bangsgaard et al 2003, Tahseen et al 2003, Mol et al 2008). The IUP rates were higher and the time to an IUP was shorter after salpingostomy compared to salpingectomy. Especially in women with history of bilateral tubal pathology, salpingostomy offered better IUP rates than salpingectomy, albeit at the cost of an increased risk for repeat EP (Silva et al 1993, Job spira et al 1996, Mol et al 1998, Bangsgaard et al 2003, Mol et al 2008). In women without history of tubal pathology, this benefit was less clear and also in these women there was an increased risk of repeat EP (Mol et al 1998, Mol et al 2008). In view of these data, it has been felt that the most effective type of surgery for women with a tubal EP in the presence of contralateral tubal pathology with desire for future pregnancy is salpingostomy. In women without contralateral tubal pathology, the most optimal surgical treatment is currently unknown.


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