Page 28 - Jourmal of World Association of Laparoscopic Surgeon

Shereen Pradeep Kumar

that wished salvage their fertility. All patients underwent a The results of a clinical trial, conducted between 1987
diagnostic laparoscopy first. Sixty patients with unruptured and 1989 at Sahlgrenska University Hospital in Goteborg,
ectopic pregnancies of 5 cm or less were randomized equally Sweden, were evaluated by the Mayo Clinic. The results
to both laparoscopy and laparotomy. The beta-hCG levels deduced by Mayo stated that the results of both surgeries
in both groups were comparable. It was seen that there was were the same but at a much lower cost. 12
lesser blood loss in those who had undergone laparoscopic Clasen et al, conducted a Belgian study, involving 293
salpingostomy, though unfortunately two patients in the cases, where they adhered to only laparoscopic management
laparoscopy group required laparotomy postoperatively. and the results favored a laparoscopic approach.
A hysterosalpingogram confirmed tubal patency (84% of Unfortunately, eight laparotomies had to be performed due
the laparoscopy and 89% of the laparotomy). Six months to intense hemorrhage and advanced gestation. Of the eight
following surgery, 56% of the patients that had undergone laparotomies performed, three were primary and five were
laparoscopy and 58% of those that had undergone converted from laparoscopy. A total of 14 cases, remained
laparotomy conceived spontaneously (Table 2). 9 with residual disease and were treated either by
A trial conducted in Kuwait, by El-Tabbakh, from March methotrexate or a second surgical procedure. This study
1999 to October 2001, involving 207 patients to compare evaluated that the overall rate of spontaneous conception
the surgical outcome of laparoscopy vs laparotomy for was 77.3% and there was a 10.6% recurrence rate of
surgical treatment of ectopic pregnancy. A total of 184 ectopic pregnancy. The author concluded that laparoscopy
patients were treated by laparoscopy and 23 by laparotomy approach should remain the gold standard in treating
of the 207 patients that had been diagnosed with ectopic ectopic pregnancy. 13
pregnancy based on clinical symptoms, history, physical A similar study was conducted by Murphy et al at the
examination, positive serum beta-hCG, transvaginal San Diego School of Medicine. Here the author ran a
ultrasonography and ectopic pregnancy conformed at prospective study, wherein they compared laparoscopy and
laparoscopy. Postoperatively, the patients were followed up laparotomy in the management of hemodynamically stable
with serial serum beta-hCG on days 4 and 7, there after patients. A total of 63 patients were included in the study
weekly until levels less than 20 IU/l were obtained. Those of which 26 underwent laparoscopy and 37 underwent
patients treated with laparoscopy had an overall success rate laparotomy. The results reported have been summarized in
of 98.9% with a significant lesser blood loss. Though, 23% the Table 4. 14
of the patients that had undergone open surgery required The study also stated that there was no statistical
blood transfusion, only 13% required it in the laparos- difference in the rate of subsequent intrauterine pregnancies
copically treated group. In this study all the patients had or ectopic pregnancies. The author has concluded that in a
the ectopic pregnancy confirmed by laparoscopy and then university-based residency program, operative laparoscopy
the decision to proceed with operative laparoscopy or
laparotomy depended on the minimally invasive surgery Table 1: Summarizing the results of the Brumsted et al study
experience of the on call surgeon. No intraoperative Laparoscopy Laparotomy
complications were reported and the duration of surgery (n = 25) (n = 76)
ranged from 1 hour to 72 minutes for both groups. The Operating time Reduced Relatively longer
author thus concluded that laparoscopic surgery offered Analgesics Decreased requirement More requirement
Hospital stay Short duration Longer duration
benefits superior to laparotomy with lesser blood loss. The
patients experienced minimal pain and therefore decreased
need for analgesia, short duration of hospital stay and early Table 2: Summarizing the results of the Vermesh et al study
recovery (Table 3). 10 Laparoscopy Laparotomy
Another study, conducted by Xiang in China, that Blood loss Reduced Relatively more
consisted of 142 patients compared the resulted of Positive tubal patency 84% 89%
Pregnancy 56% 58%
laparoscopic surgery and laparotomy in the management
of ectopic pregnancy. Seventy patients were treated by the
conventional laparotomy and the remaining 72 by Table 3: Summarizing the results of the El-Tabbhak study
laparoscopy. It was found that of the patients who were Laparoscopy Laparotomy
treated laparoscopically the operating time and the (n = 184) (n = 23)
postoperative hospital stay was significantly reduced. This Operating time 66-72 mins 66-72 mins
method of treatment was also found to be more convenient Blood loss 13% 23%
to both the surgeons as well as the patients. 11 Hospital stay Short duration Longer duration
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