Page 27 - Jourmal of World Association of Laparoscopic Surgeon

WJOLS

10.5005/jp-journals-10033-1177
REVIEW ARTICLE Comparing Laparoscopic and Laparotomy for the Surgical Management of Ectopic Pregnancy
Comparing Laparoscopic and Laparotomy for the

Surgical Management of Ectopic Pregnancy

Shereen Pradeep Kumar

ABSTRACT laparoscopic approach has become the preferred surgical
method, and that a laparotomy should be reserved for
Ectopic pregnancy is the most common life-threatening
emergency in early pregnancy. This complication results in not patients that are hemodynamically unstable. Laparotomy
only fetal loss, but also causes significant maternal morbidity may be preferable in the likely event of extensive pelvic
and mortality. A literature search was carried out using various adhesions where it is impossible to view the ectopic or in
search engines and the selected articles were analyzed on the
outcomes, such as success of the surgery, operating time, cases of nontubal, intra-abdominal ectopic gestation, where
intraoperative and postoperative complications, hospital stay, other pelvic structures could be involved. 7
future fertility, convalescence and cost effectiveness. After As a result of the continual debate, this topic was chosen
having analyzed the same it can be concluded that laparoscopic to review the two methods and to analyze the preferred
surgery is safe, effective and economical when compared to
open laparotomy as the surgical treatment for ectopic pregnancy, choice surgery.
and that it should be considered as the gold standard method
in managing ectopic pregnancies. OBJECTIVE
Keywords: Ectopic pregnancy, Laparoscopy, Laparotomy. To compare the surgical outcomes of laparoscopic and

How to cite this article: Kumar SP. Comparing Laparoscopic laparotomy for the management of ectopic pregnancy.
and Laparotomy for the Surgical Management of Ectopic
Pregnancy. World J Lap Surg 2013;6(1):29-32. MATERIALS AND METHODS
Source of support: Nil A literature search was performed using search engines such
Conflict of interest: None declared as Google, HighWire press and PubMed. The selected
papers were analyzed on the basis of the outcomes of both
INTRODUCTION laparoscopy and laparotomy in the management of ectopic
pregnancy.
An ectopic pregnancy is a complication of pregnancy
wherein the fertilized embryo gets implanted outside the RESULTS
1
uterine cavity. A majority of ectopic pregnancies are found
to be within the fallopian tube. The ampullary part of the One of the earliest reported comparisons between
fallopian tube has the highest incidence of ectopic laparoscopy and laparotomy for the surgical management
pregnancies (80%), followed by the isthmus (12%), fimbrial of ectopic pregnancies was by Brumsted et al, at the
(5%) and the cornual and interstitial part of the tube (2%). 2 University of Vermont. The study was a retrospective case
An ectopic pregnancy is a medical emergency which is the control that involved 101 cases of ectopic pregnancy,
currently the leading cause of maternal mortality in the first conducted between 1982 and 1987. The study compared
3-5
trimester of pregnancy. During the 19th century surviving the difference in outcomes in patients managed by both
an ectopic pregnancy was bleak, but toward the turn of the methods. Twenty-five patients were treated by laparoscopy
20th century, with advances in anesthesia, antibiotics, and and 76 by laparotomy. There were no guidelines used while
blood transfusions mortality has reduced significantly. 1 choosing a method of surgery but only the patients who
There are several treatment modalities for treating were hemodynamically unstable were treated by laparotomy.
ectopic pregnancies, however if hemorrhage has already The author concluded the study with the results that patients
occurred, surgical intervention may be necessary. The treated by laparoscopic surgery required less operating time,
preferred method of surgical management is to perform a decreased requirement for analgesics, shorter hospitalization
salpingostomy or a salpingectomy. Dr John Bard, from New and early convalescence (Table 1). 8
York, reported the first successful open surgical intervention Vermesh et al conceived a prospective study where the
to treat an ectopic pregnancy in 1759. Bruhart et al reported factors considered were morbidity, cost of the surgery,
the first laparoscopic surgery for ectopic pregnancy in 1980. 6 postoperative hospital stay and outcome of fertility
Innovations in the surgical field have now lead to the following linear salpingostomy by laparoscopy vs
debate of which would be the preferred route for performing laparotomy. The inclusion criteria included stable vital signs,
the surgery–laparoscopy vs laparotomy. Seeber stated that hematocrit more than 30%, age over 18 years, and those
World Journal of Laparoscopic Surgery, January-April 2013;6(1):29-32 29