A rare case of extraluminal interstitial pregnancy treated with laparoscopic cornuotomy.

We report an extremely rare case of an extraluminal interstitial pregnancy. A 36-year-old nulliparous woman visited our hospital during the fifth week of gestation. Although no intrauterine gestational sac (GS) was identified, transabdominal ultrasonography revealed a GS-like cyst was detected in the right uterine horn. She underwent laparoscopic surgery for a suspected interstitial ectopic pregnancy. After laparoscopic cornuotomy, dye leakage was observed from the fimbria rather than the incision site. Finally, the patient was diagnosed with a right extraluminal interstitial pregnancy. Hysterosalpingography performed at three postoperative months revealed bilateral tubal passage. She conceived 7 months after surgery, with safe delivery by elective cesarean section at 38 weeks.

[The clinical efficacy of laparoscopic cornuotomy on interstitial tubal pregnancy which diameter was shorter than 3 cm].

Objective: To investigate the clinical efficacy of Laparoscopic cornuotomy on Interstitial Tubal Pregnancy (IP) which diameter was shorter than 3 cm. Methods: The women who had IP under 3 cm diameter were selected from January, 2016 to December, 2018 at the Department of Gynecology, JiaXing Maternity and Child Health care Hospital. A total of 32 IP patients were divided into two groups. They were all treated with laparoscopic surgery. 17 patients were in study group, conducted by a cornuotomy and suturing the cornual.15 patients were in control group, conducted by a cornual resection and suturing the cornual. Patients' genenral conditions were not significantly different(all P values>0.05). The peri-surgical data and the related clinical data were compared in the two groups. Results: All the 32 patients were successfully treated by laparoscopic surgery. The mean operating time was significantly shorter for cornuotomy than for cornual resection[ (33±6) min vs (53±9) min, P<0.05].Changes in blood loss[(45±5) ml vs (50±7) ml]、the total hospital stays[ (4.4±1.4) d vs (4.6±1.4) d] and the recovery time of HCG[(16±5) d vs (15±5) d] were not significantly different between the two groups (all P values>0.05) . There were no persistent ectopic pregnancy and uterine rupture happened in two groups. Compared with the control group,the interval time to pregnancy was shorter[ (8±3) m vs (16±4) m, P<0.05] and the number of full-term pregnancy cases were more (9 vs 3, P<0.05). Conclusion: The Laparoscopic cornuotomy was feasible and safe on interstitial tubal pregnancy which diameter was shorter than 3cm. It deserved popularization in the clinical work and regarded as one of selection operative treatment on interstitial heterotopic pregnancy.

Cornual wedge resection for interstitial pregnancy and postoperative outcome.

INTRODUCTION: Traditionally, interstitial pregnancies were treated with cornual resection or hysterectomy via laparotomy. However, increasingly, interstitial pregnancies are treated with laparoscopic cornuotomy, ie, removal of ectopic pregnancy tissue with preservation of uterine architecture. Although this technique may increase the incidence of persistent and recurrent interstitial pregnancy, it can potentially maintain patient fertility and decrease their risk for future uterine rupture. In a case series of patients with interstitial pregnancies treated with cornual wedge resection, we examined fertility outcomes, rates of subsequent uterine rupture, and rates of persistent or recurrent interstitial pregnancy. MATERIALS AND METHODS: We conducted a retrospective medical record review of cases (n = 29) of cornual wedge resection for interstitial pregnancy, performed between 1992 and 2013 at one hospital. RESULTS: Of the 29 cases, two later presented with uterine rupture; one, who also had a prior wedge resection, was found with scar dehiscence during a subsequent caesarean section. The incidence of subsequent uterine rupture and dehiscence was 30%. There were no cases of persistent ectopic pregnancy or recurrent interstitial pregnancy. Most (71.4%) patients who were trying to conceive achieved subsequent pregnancy. DISCUSSION: There is debate regarding the recommended surgical technique to treat interstitial pregnancies; cornual resection and cornuotomy are both important considerations. Choice of the technique employed continues to require careful consideration.

Laparoscopic cornuotomy for interstitial pregnancy and postoperative course.

AIM: The aim of this study was to evaluate the advantages of laparoscopic cornuotomy in treating interstitial pregnancy, and the effect of the procedure on reproductive outcomes. METHODS: Thirteen patients were treated for interstitial pregnancy by laparoscopic cornuotomy with or without local methotrexate injection, between March 2000 and January 2012 at NTT East Japan Tohoku Hospital and Sendai City Hospital. The patients were followed to assess the outcomes of subsequent pregnancies for at least 1 year after the operation. RESULTS: All 13 cases of interstitial pregnancy were successfully treated by laparoscopic cornuotomy, without performing cornual resection or laparotomy. The mean gestational age was 7.6 ± 1.3 weeks, and the average serum hCG level was 20,800 ± 18,100 IU/L. The mean cornual mass size was 34.6 ± 10.2 mm. Eight of the patients later obtained a spontaneous intrauterine pregnancy. Three patients that delivered by cesarean section showed no uterine dehiscence or thinning of the scar at the site of the earlier cornual incision and repair. None of the patients experienced uterine rupture. CONCLUSION: Interstitial pregnancy can be selectively treated by laparoscopic cornuotomy with local methotrexate injection, if managed carefully.

Comparative Study on Surgical Outcomes between Laparoscopic and Open Cornuotomy in Urban Tertiary Center of Malaysia.

STUDY OBJECTIVE: The objective of the study was to evaluate the prevalence of interstitial ectopic pregnancy and to compare the surgical outcomes of laparoscopic cornuotomy (LC) and laparotomy (open) cornuotomy (OC) of cornual ectopic pregnancy and to analyze its associated factors. MATERIALS AND METHODS: A cross-sectional study was conducted involving cases of interstitial ectopic in Hospital Putrajaya, Putrajaya, Malaysia, over a 10-year period (2005-2014). Data on sociodemographic, clinical profile, perioperative, and postoperative were obtained from the electronic medical records. MEASUREMENT AND MAIN RESULTS: The prevalence of cornual pregnancy was 4.0% (n = 14) out of total 347 cases of all ectopic pregnancies in Putrajaya Hospital. The mean ± standard deviation age of patient in the LC group and OC group was 29.3 ± 5.9 years and 31.4 ± 7.3 years, respectively. The duration of hospitalization and mean operating time were both significantly shorter in the LC group than in the OC group (1.43 ± 0.54 versus 2.57 ± 0.79 and 61.4 ± 15.7 min versus 97.1 ± 38.2 min, respectively, P < 0.05).There were no statistically significant differences between both groups for the estimated blood loss, requirement of blood transfusion, complications, and future fertility. CONCLUSION: Laparoscopic cornual resection (cornuotomy) is a safe and less invasive procedure with a comparable complication rate. It has shown that it is feasibility and should be considered as initial treatment in managing those cases in trained hand surgeons.

Management of a cornual ectopic pregnancy.

Cornual pregnancy is rare. Treatment involves expulsion of the pregnancy and hemostasis of the cornus if required by hemorrhagic rupture. Two techniques are proposed to achieve hemostasis of the uterine cornus, cornuotomy with suture, or corneal resection with salpingectomy, generally laparoscopically.