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10.5005/jp-journals-10007-1103 WJOLS
REVIEW ARTICLE To Evaluate the Efficacy of Laparoscopic versus Open Surgical Management of the Tubal Pregnancy
To Evaluate the Efficacy of Laparoscopic versus

Open Surgical Management of the Tubal

Pregnancy and its Effects on Future Pregnancy

Amardeep Bhimrao Tembhare
Specialist, Department of Gynecology and Laparoscopy Surgery, Member of World Association of Laparoscopic Surgery
(WALS), Member of Federation of Obstetrics and Gynecological Societies of India (FOGSI), India

Abstract
Ectopic pregnancy is the most common cause of maternal death in early pregnancy and its incidence is rising. Most of the ectopic
pregnancies occur in the young age group and subsequent fertility is an important issue. There is no consensus in the literature
regarding conservative laparoscopic versus radical treatment of tubal pregnancy in terms of future reproductive performance. There
are no randomized controlled trials of sufficient power, and meta-analysis of studies has shown different results with different investigators.
But in certain studies laparoscopic surgery has advantages over open surgery and results in higher rates of subsequent intrauterine
pregnancies and a lower rate of ectopic pregnancy.
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.
Keywords: Ectopic pregnancy, Operative laparoscopy, Laparoscopic, Laparotomy salpingectomy, Surgical treatment, Minimal access
surgery, Future pregnancy.

INTRODUCTION and the option of conservative surgical management of an
unruptured fallopian tube is now a viable alternative.
Lawson Tait, the father of gynecologic surgery reported
the first successful operation for ectopic pregnancy in 1883.
His main difficulty lay in establishing the diagnosis (Tait RL INCIDENCE AND RISK FACTORS
1884). Ectopic pregnancy is the most common cause of maternal
Until little more than a decade ago, little change had death in early pregnancy (RCOG 1997-1999) and its
occurred in the diagnosis and management of ectopic incidence is on rise. Most of the ectopic pregnancies occur
pregnancy. The clinical use of sensitive pregnancy testing, in the young age group, and subsequent fertility is an
transvaginal ultrasonography, and diagnostic laparoscopy important issue. Ectopic pregnancy is the one in which the
has had a major impact on the preoperative diagnosis of fertilized ovum implants outside the uterine cavity. Its
this condition. The rate of ectopic rupture has declined, incidence has increased from 0.5 per 100 pregnancies

World Journal of Laparoscopic Surgery, September-December 2010;3(3):153-158 153