Page 35 - World's Most Popular Laparoscopic Journal

Amardeep Bhimrao Tembhare

cantly higher postectopic intrauterine pregnancy rates salpingotomy vs salpingectomy in patients with and without
(P < 0.05) compared with the laparotomy group. additional fertility reducing factors, and found that the
Laparoscopic management of ectopic pregnancy is a viable laparoscopic salpingotomy is of particular benefit for patients
alternative to conventional laparotomy in district general with additional fertility reducing factors desirous of future
hospitals also. pregnancy. Reproductive outcome is excellent in patients
Lundoff (1997) conducted a randomized, prospective without such risk factors irrespective of the surgical
clinical trial to compare the efficacy of laparoscopic approach.
treatment versus conventional conservative abdominal Zhang et al (2010) favored the treatment of ectopic
surgery for tubal pregnancy, and concluded that patients pregnancy with laparoscopic approach. In their study of
treated by laparoscopy had a shorter hospital stay and a 226 cases from January 2003 to December 2008, authors
shorter convalescence than patients from the laparotomy concluded that in order to preserve fertility, laparoscopic
group. conservative surgery was a safe and feasible approach in
Lo et al (1999) performed a prospective nonrandomized treatment of tubal pregnancy. A word of caution added is
multicenter study to compare laparoscopic surgery and that the preoperative serum hCG levels, size of tube
laparotomy in the immediate surgical outcome of tubal gestational sac were significant factors influencing
ectopic pregnancy (TEP), at nine teaching hospitals in Hong successful laparoscopic surgery.
Kong. After exclusion of patients with shock, laparoscopic Cochrane database review suggests different conclusions
surgery offered a significantly shorter postoperative hospital over different issues like intraoperative bleeding, need for
stay (mean 2.7 days vs 5.3 days), a slightly lower intraoperative blood transfusion, hospital stay, cost,
perioperative complication rate (8.1% vs 13.9%), and more recurrence of the ectopic pregnancy and future pregnancy.
conservative surgery (90.1% of all salpingotomies) than Cochrane database (2007) reviewed the various treatment
laparotomy. A longer operating time was needed for options and commented that the laparoscopic conservative
laparoscopic surgery (1.2 hours vs 1.01 hours), which was surgery is significantly less successful than the open surgical
not statistically significant. approach in the elimination of tubal pregnancy due to higher
Saleh et al (2003) in his study suggested that there were persistent trophoblast rate of laparoscopic surgery. Long
significant reductions of total blood loss, number of blood term follow-up shows similar tubal patency rates whereas
transfusion units, and duration of hospital stay in the the number of subsequent intrauterine pregnancies is
laparoscopic group compared to the laparotomy group. The comparable, and the number of repeat ectopic pregnancies
rates of subsequent intrauterine pregnancies were 74% (17/ lowers, although these differences are not statistically
23) in the laparoscopy group and 61%, (19/31) in the significant. The laparoscopic approach is less costly as a
laparotomy group, and the rates of subsequent ectopic result of significantly less blood loss and analgesic
pregnancies were 4% (1/23) in the laparoscopy group and requirement, and a shorter duration of operation time, hospital
10% (3/31) in the laparotomy group concluding that stay, and convalescence time.
laparoscopic treatment of ectopic pregnancy in Supporting the Cochrane database (2007), Desroque et
hemodynamically stable patients offers major economic al (2010) reviewed 24 papers of randomized control trial
benefits superior to laparotomy in terms of less need for (RCT) or observational studies and concluded that there is
blood transfusion, shorter duration of hospital stay and no difference between laparotomy and laparoscopy as
convalescence, and future pregnancy outcome. fertility was found.
Tahseen et al (2003) concluded that laparoscopic surgery
has advantages over open surgery and results in higher rates CONCLUSION
of subsequent intrauterine pregnancies and a lower rate of Critical overview of literature of all possible approach
ectopic pregnancy. Authors also concluded the higher demonstrates that the minimally access surgery is not only
intrauterine pregnancy (IUP) rates after salpingotomy safe and effective but also economical than open laparotomy
(2-23% higher IUP rates) than after salpingectomy. in the treatment of ectopic pregnancy and should consider
Becker et al (2009) raised a concern as the most ectopic as the gold standard in treating ectopic pregnancy. Not only
pregnancy cases now diagnosed and treated, early future in terms of short-term advantages of surgery, but it also
reproductive outcome needs to be evaluated critically. had positive effects on the future pregnancy. Though certain
Authors evaluated long-term reproductive outcome after studies and Cochrane database, and other recent studies

156
JAYPEE