Surgical treatment of ectopic pregnancy associated with predisposing factors of tuboperitoneal infertility

Therapeutic effect of laparoscopic salpingotomy vs. salpingectomy on patients with ectopic pregnancy: A systematic review and meta-analysis

Background and aim

Laparoscopic treatment of ectopic pregnancy mainly includes laparoscopic salpingotomy and salpingectomy. We aimed to assess the therapeutic effect of laparoscopic salpingotomy and salpingectomy on patients with tubal pregnancy.

Methods

From January 2000 through June 2022, the Cochrane Library, Medline, PubMed, Web of Science, EMBASE, and the Chinese Biomedicine Database were searched for studies that compared the therapeutic effect of laparoscopic salpingotomy vs. salpingectomy in the treatment of tubal pregnancy.

Results

Twenty-four randomized clinical trials (RCTs) studies were incorporated into this analysis. No statistical differences were found between the two groups in terms of operation duration and postoperative hospitalize length, but the volume of intraoperative blood loss in patients with laparoscopic salpingotomy was less than that in salpingectomy. Importantly, the natural intrauterine pregnancy rate after laparoscopic salpingotomy was significantly higher than those who underwent salpingectomy. In addition, laparoscopic salpingotomy can better protect the ovarian reserve function and endocrine function and provide favorable conditions for the second pregnancy.

Conclusion

Patients with ectopic tubal pregnancy should give priority to laparoscopic salpingotomy for embryo extraction.

Salpingotomy versus salpingectomy in women with tubal pregnancy

Evaluation of: Mol F, van Mello NM, Strandell A et al. Salpingotomy versus salpingectomy in women with tubal pregnancy (ESEP study): an open-label, multicentre, randomised controlled trial. Lancet 383(9927), 1483-1439 (2014). Ectopic pregnancy can still manifest itself as a life-threatening condition and, hence, the establishment of accurate evidence-based treatment modalities remain paramount. Surgical treatment has long been a mainstay of ectopic pregnancy treatment. To date, there is a wealth of data establishing laparoscopic treatment as the 'gold standard'; however, paradoxically, the evidence behind choosing the two main treatment methods of salpingotomy and salpingectomy, especially with regards to future fertility potential, remain unclear. This article is a summary of a randomized controlled trial of salpingotomy versus salpingectomy in patients with an apparent contralateral healthy tube and the impact on future fertility. It attempts to answer the clinical question whether preservation of tube by salpingotomy increases the futures chances of natural conception as opposed to salpingectomy.