Page 29 - Jourmal of World Association of Laparoscopic Surgeon

WJOLS

Comparing Laparoscopic and Laparotomy for the Surgical Management of Ectopic Pregnancy

Table 4: Summarizing the results of the Murphy et al study The study concludes that laparoscopic treatment of tubal
pregnancy was seen to be a safe and effective alternative to
Laparoscopy Laparotomy
(n = 26) (n = 37) laparotomy, yielding similar fertility outcomes and requiring
Operating time Comparable Comparable significantly less postoperative analgesia and a significantly
Blood loss Significantly reduced Significantly more shorter hospital stay. 17
Hospital stay Short duration Longer duration With the introduction of laparoscopic services to the
Analgesic Less More
requirement Obstetrics and Gynecology Department at South Cleveland
Total hospital cost Less More Hospital, the department decided to review their
Return to normal Early recovery Late recovery
activity management of ectopic pregnancies. A retrospective
analysis of 210 cases of ectopic pregnancy managed over a
period of 5 years, including the operative findings and
is a safe alternative for the management of appropriately
selected patients with suspected ectopic pregnancy. 14 surgical data were analyzed. All the patients with an ectopic
pregnancy were treated surgically. One hundred and
The Department of Gynaecology and Obstetrics, E.
Wolfson Medical Center, Israel, designed a parallel study seventy-seven patients were managed successfully by
laparoscopy, with no major intraoperative or postoperative
but on hemodynamically unstable patients. One hundred complications. Thirty-three women were managed by
and one women with ectopic pregnancy underwent laparotomy for various reasons. Of these 22.9% achieved a
laparoscopic surgery. Of which 18 had substantial intra- successful pregnancy and delivery. The estimated blood loss,
abdominal bleeding and clinical signs and symptoms of the need for blood transfusion and the length of hospital
hemodynamic instability. These patients underwent stay following laparoscopic treatment were significantly less
laparoscopic salpingectomy and only one required than those in laparotomy group. This study demonstrated
conversion to laparotomy. There were no major that laparoscopic management of ectopic pregnancy is the
intraoperative or postoperative complications, and all the most beneficial procedure with maximum safety. 18
women made a full and uneventful recovery. The study was
concluded with the statement that improved anesthesia and DISCUSSION
cardiovascular monitoring, combined with advanced A large number of studies have been published on the
laparoscopic surgical skills and experience, justifies management of ectopic pregnancy. They range from case
operative laparoscopy for the surgical treatment of ectopic reports to randomized trials, from conservative management
pregnancy even in women that are hemodynamically to radical surgery. Though now it is accepted that
unstable. 15 laparoscopy should be the gold standard for the surgical
A French institute conducted a study where 100 ectopic treatment of ectopic pregnancies unless absolutely
pregnancies were operated on by laparoscopy. The different contraindicated.
techniques used included salpingostomy, salpingectomy and • Success of the surgery: Clasen et al performed only
tubal expression. There were no intraoperative laparoscopic approach to 194 cases of ectopic pregnancy
complications. Though on the fourth postoperative day, one resulting in a 97.4% success rate. Other series of
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patient underwent a laparotomy due to an occlusive studies also confirm the success rate of operative
syndrome. Six failures, in cases of conservative treatment laparoscopic surgery in ectopic pregnancy between
were observed including three after tubal expression. The 87 to 97%. 16-18 Some authors had performed operative
length of operation and hospitalization is similar with regard laparoscopic even in hemodynamically unstable patients
to the different endoscopic procedures, and shorter than with good success rate. 14
those observed after treatment by laparotomy. These results • Operative time: Gray et al conducted a randomized,
confirm that laparoscopic treatment of ectopic pregnancies prospective clinical trial to compare the efficacy of
is not only reliable but also significantly less expensive than laparoscopic surgery over conventional surgical
treatment by means of classical surgery. 16 methods. Laparoscopic surgery took less time while
A study by Zouves et al analyzed the intraoperative compared to those that underwent laparotomy. In fact,
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morbidity, postoperative course, postoperative hospital stay it actually saves time, as during a laparotomy, opening
and fertility outcome in 216 consecutive tubal pregnancies the abdomen to gain access to correct site of the affected
treated with either laparoscopy or laparotomy. Among the tube takes up operating time. Other studies have
98 cases treated with laparoscopy, the procedure was supported this fact. 16,17,19
successfully completed in 95 (97%). In three cases • Intraoperative and postoperative complications: The
laparotomy had to be performed to conclude the procedure. study conducted by Chatwani et al stated a statically
World Journal of Laparoscopic Surgery, January-April 2013;6(1):29-32 31