Factors Affecting Success of Laparoscopic Salpingostomy for Tubal Ectopic Pregnancy: One Hundred Case Experience

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DOI: 10.4236/ojog.2019.912151    825 Downloads   2,407 Views  
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ABSTRACT

Objective: The aim of this work is to predict those patients who will have a successful laparoscopic salpingostomy from those who will be obligated to go for salpingectomy. Methods: This study included 100 cases of diagnosed ectopic pregnancy in low parity women and was prepared for laparoscopic salpingostomy versus salpingectomy. Clinical data were collected from the patients (parity, gestational age and clinical presentation), b-hcg, ultrasound data (vascularity of the mass, viability of fetal pole and site of the ectopic in relation of the ipsilateral ovary), laparoscopic data (presence of mass invasion of the tube, free fluid in Douglas pouch, start of tubal abortion and site of ectopic). Then we started to do salpingostomy on the antimesenteric border of fallopian tube using the spatula with monopolar diathermy and try to remove the conceptus from the tube with hydro dissection and check bleeding from the implantation site, only cauterization of the edges of the tubes at the site of salpingostomy was allowed. The process was called to be successful if no more bleeding from the fallopian tube and tubes were conserved, but it was a failed procedure if too much bleeding from the bed of fallopian tube and laparoscopic salpingectomy was done. Results: 28 cases (28%) had laparoscopic salpingostomy (success group) and 72 cases (72%) failed salpingostomy and we went for laparoscopic salpingectomy (failure group). 67 cases with the ectopic in the medial 1/2 of the tube (from which 15 case had salpingostomy and 52 cases had salpingectomy) and 33 cases with ectopic in the lateral 1/2 of the tube (from which 12 cases had salpingostomy and 20 cases had salpingectomy) with no significant difference in both groups (P value 0.075). 42 case showed start of tubal abortion of which 24 cases (57.2%) had salpingostomy and 18 cases (42.8%) had salpingectomy with highly significant difference between both groups (P value 0.000). 52 cases during laparoscopy showed invasion of the mass to the fallopian tube and impending tubal rupture, from this group 21 cases had salpingostomy and 31 cases had salpingectomy. Conclusions: In tubal pregnancy, presence of non-viable fetal pole together with signs of start of tubal abortion and presence of mild free fluid in Douglas pouch and no mass invasion of the fallopian tube can effectively predict the success of laparoscopic salpingostomy and tubal conservation with no need for salpingectomy in low parity females.

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Hamed, B. and Nagy, A. (2019) Factors Affecting Success of Laparoscopic Salpingostomy for Tubal Ectopic Pregnancy: One Hundred Case Experience. Open Journal of Obstetrics and Gynecology, 9, 1549-1557. doi: 10.4236/ojog.2019.912151.
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