Page 35 - WALS Journal

Babita Gupta
Laparotomy Hospital Stay

Laparotomy was performed through a pfannenstiel incision and Various randomized control trial comparing laparoscopic surgery
standard surgical techniques (the same laparoscopic versus laparotomy in treatment of ectopic pregnancy showed
techniques) were applied. shorter hospital stay and convalescence period. 22, 24
Postoperative follow-up consists of serial hCG assessment
(twice weekly) until complete negativity (< 5IU/L), with weekly Fertility Outcome
clinical examination and transvaginal ultrasound if needed. Concern fertility restoration and pregnancy outcome following
Postoperative management follows the normal practice. conservative or radical approach by minimal access surgery
Analgesia was prescribed to the patients on demand, namely proved no significant difference when compared with open
pethidine, 1.5 ml/kg IM every 4 four hours or diclofenac sodium surgery. Overall conception rate of 77.3%, with an ongoing
100 mg. pregnancy rate 81.2% have been reported. 30, 31

DISCUSSION Cost Effectiveness
A large number of studies on the management of ectopic In this current era of minimal access surgery the cost of
pregnancy can be found in the literature, ranging from case endoscopic/laparoscopic set up is much high and need
report to randomized trial, from expectant management to radical specialized theater set up, more staff and maintenance. But
surgery. It is now accepted that the surgical treatment of ectopic owing to reduce hospital stay, faster recovery time, the
pregnancy should be via laparoscopy except for a few exception expenditure can be considered cost effective. 22, 23
(contraindication for laparoscopy, state of hemodynamic shock,
surgeon with insufficient experience). Quality of Life Analysis
Success Rate – K Clasen et al (1997) had strict laparoscopic Minimal access surgery as an operative choice for management
approach to 194 cases of ectopic pregnancy resulting in a 97.4% of life-threatening condition like ectopic pregnancy lead to
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success rate. Other series of studies also confirm the success increased quality of life in term of shorter hospital stay, speedy
rate of operative laparoscopic surgery in ectopic pregnancy postoperative recovery, reduce need of postoperative analgesia,
between 87-97%. 26-30 cosmetically good scar and less psychological trauma to the
Some authors had performed operative laparoscopic even patients.
in hemodynamically unstable patients with good success rate. 9
CONCLUSION
Operative Time
Critical overview of literature of all possible approach
Lundorff P et al 1991 conducted a randomized, prospective demonstrate that the minimally access surgery is not only safe
clinical trial was conducted to comparing the efficacy of and effective, but also economical then open laparotomy in the
laparoscopic treatment with conventional conservative treatment of ectopic pregnancy and should consider as the
abdominal surgery for tubal pregnancy. Laparoscopic surgery gold standard in treating in ectopic pregnancy.
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took less time (73 min) versus 88 min for laparotomy group. In
fact, it actually saves time, as during a laparotomy, opening and REFERENCES
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consumes precious operating time. Other comparative studies pregnancy. Arch Gynecol Obstet 2000 Feb; 263(3): 87-92.
support this fact. 22,26,27 2. Centres for diseases control (CDC). Ectopic pregnancy—United
States, 1988-1989. MMWR 1992; 41:591-94.
Peri- or Postoperative Complication 3. Centres for disease contral (CDC). Ectopic pregnancy—United
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Chatwani A et al in non-randomized study found statically 4. Why women die. Report on condiential enquiries into maternal
significant decrease in operative blood transfustion rate in deaths in the United Kingdom 1994-1996. Norwich: Stationery
laparoscopic group. Another review article by Mohammed H. Office, 1998.
(2002) suggested that there was no major difference in 5. Leach RE, Ory SJ. Management of ectopic pregnancy. Am Farm
intraoperative or postoperative complications in laparoscopic Physician 1990; 41: 1215-22.
group and laparotomy group. 20, 21 6. Ory SJ. New options for diagnosis and treatment of ectopic
pregnancy. JAMA 1992; 267:534-37.

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