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To Evaluate the Efficacy of Laparoscopic versus Open Surgical Management of the Tubal Pregnancy

et al 1973, Bruhat et al 1980, DeCherney et al 1981, 2008). reduced need of postoperative analgesia, cosmetically good
Rates of conception of an intrauterine pregnancy after the scar and less psychological trauma to the patients.
procedure were as high as 70% in these cases. Pouly and Karsten et al (1990) also favored the laparoscopy over
associates (Pauly et al 1986) reported on 321 women with the laparotomy. He concluded that endoscopic management
ectopic pregnancies who underwent conservative of ectopic pregnancy is recommended due to low
laparoscopic treatment. Of the women who did not have a postoperative morbidity rates and short time of
history of infertility or previous ectopic pregnancy, 86% hospitalization, and also positive effect on future pregnancy.
had a subsequent intrauterine pregnancy. Pauli et al (1991) in their study also commented that in
The advantages of laparoscopic removal of an ectopic the absence of few rare contraindications, the most
pregnancy are a shortened operating time, convalescence, satisfactory surgical treatment of extrauterine pregnancy at
and hospital stay. It is imperative, however that proper case present was laparoscopy. The authors found in their series
selection be exercised (Brumsted et al 1988, DeCherney et of 223 patients desiring subsequent pregnancy that factors
al 2008). If laparoscopic therapy is to be warranted, the significantly affecting the fertility prognosis included the
first criterion is the expertise of the operator in performance presence of adhesions on the tube, the condition of
of a laparoscopic surgical procedure. Patients must be stable contralateral tube, and a history of salpingitis. Neither age,
without evidence of a significant hemoperitoneum. parity nor the characteristics of extrauterine pregnancy
One of the complications of conservative surgery via significantly affected the possibility of pregnancy in future.
laparoscopy, persistent ectopic pregnancy, appears to be In the era of laparoscopic carbon dioxide laser surgery,
higher with laparoscopy (5-20% vs 2-11%). This is thought Langebrekke et al (1993) suggested in his study of 150
to be associated with the learning curve seen with laparos- women with tubal pregnancy consecutively treated over a
copy. Optimally, the ectopic pregnancy should be confined two years period by laparoscopic techniques. Sixty-six
to the ampullary portion of the tube and should be atleast percent (38/58) of those women who desired pregnancy
2 cm in size (Lipscomb et al 2005, DeCherney et al 2008).
after conservative laparoscopic treatment achieved an
DISCUSSION intrauterine pregnancy. The corresponding rate for women
who desired pregnancy after salpingectomy was 45%
The incidence of ectopic pregnancy has remained static in (18/40). The recurrent ectopic pregnancy rates in two
recent years, i.e. 11.1/1000 pregnancies (RCOG 2004, groups were 7% (4/58) and 10% (4/40) respectively. This
Bangesh et al 2004, Wasim et al 2004, Lozean et al 2005). study confirms that tubal pregnancy can be appropriately
In this study, the rate was found to be 10/1000 deliveries, managed by laparoscopic laser surgery with the advantages
which is comparable. Ectopic pregnancy affects young of minimal invasive techniques and also the laparoscopic
women. The mean age was found to be 28 years and majority management helps for better fertility outcome in future.
of them were multigravida. The commonest presenting Oelsner et al (1994) studied that the reproductive
symptom was abdominal pain (100%). These results are performance following salpingectomy did not differ
comparable with other studies (Bangesh et al 2004, Wasim significantly whether by laparotomy or laparoscopy. The
et al 2004, Ben et al 2006).
Historically, the treatment of ectopic pregnancy was intrauterine pregnancy rate was 78 and 64% respectively
emergency laparotomy and salpingectomy. Nowadays, and the repeat ectopic pregnancy rate was 12 and 6%
laparoscopic treatment is being considered the gold respectively. Salpingectomy via laparoscopy can be
standard in hemodynamically stable patients, particularly performed safely with a low incidence of complications
where expertise is available. To minimize the morbidity, with subsequent reproductive performance comparable to
mortality and financial burden created by this rapidly laparotomy.
growing health problem, nonsurgical alternatives are Akrong et al (1996) in his two years retrospective study
increasingly being investigated (Korhoren et al 1996, reviewed the outcome of laparoscopic management versus
Lozean et al 2005). laparotomy for the management of ectopic pregnancy. He
Minimal access surgery, as an operative choice for found that there was no significant difference between the
management of life-threatening condition like ectopic operating times and complications but the laparoscopy group
pregnancy, leads to increased quality of life in terms of had significantly fewer doses of opiate analgesia
shorter hospital stay, speedy postoperative recovery, (P < 0.05), shorter length of stay (P < 0.05), and signifi-

World Journal of Laparoscopic Surgery, September-December 2010;3(3):153-158 155