Conservative laparoscopic management of tubal ectopic pregnancy

To study the success, safely and post-operative reproductive performane of conservative laparoscopic treatment of ectopic pregnancy [EP]. Study design: 32 cases of EP were retrospectively analyzed. These cases were managed during the period from Jnuary 1992 to Jnuary 1996. Out of these cases, 24 were primarily treated by laparoscopy and 8 with laparotomy due to hypovolemia and shock at the time of hospital admission [3], previous multiple abdominal surgery [2], extensive pelvic adhesions [1], associated uterine myomas [1] and anesthesia contraindication to laparoscopy [1]. The twenty four cases treated by laparoscopy were analyzed as regards the type and site of EP, type of sugery done, operation time and intra- and post-operative complications. Follow up of 28 out of the 32 patients was available as regards subsequent fertility. Out of the 24 patients primarily treated by laproscopy, 23 [95,8%] were successfully managed by laparoscopy alone and only one [4.2%] needed laparotomy due to intra-operative hemorrhage. Seventeen patients [70.8%] were subjected to laparoscopic linear salpingostomy, two patients had complete tubal abortion at the time of laparoscopy [8.4%] and laparoscopic salpiagectomy was done in the remaining 5 patients [20.8%] due to ruptured tube [4] and the absence of need for further pregnancy [1]. In all patients who were successfully treated by laparoscopy, there was no need for blood transfusion and no major intra- or post-operative complications. The mean duration for hospital stay was 25.3 hours for laparoscopically treated patients and 3.6 days for those treated by laparotomy. Twenty-eight patients [out of the original 32 cases of EP] requesting further pregnancy, 18 [64.3%] delivered a living infant within 24 months of follow up. Laparoscopic management of tubal EP is recommended in all cases except those who are shocked; hemodynamically unstable or those with other contra-indications to laparoscopy. Conservative salpingostomy is recommended in cases with unruptured tube that request future pregnancy