Conservative laparoscopic treatment of ectopic pregnancies using the CO2-laser

Abstract

Objective: To assess the feasibility of CO2-laser-endoscopic surgical treatment for large and/or ruptured ectopic pregnancies, and to compare the results with those of microsurgical salpingotomy.

Design: A retrospective review of all women treated for an ectopic pregnancy during a 6-year period, 1984-1989. During 1988 and 1989 treatment was randomized by the day of admission, depending only upon the surgeon in charge, some performing a linear salpingotomy (n = 42) and some a CO2-laser laparoscopy (n = 34) in all women haemodynamically stable.

Setting: Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven.

Subjects: 135 women with ectopic pregnancies of whom 76 were included in the randomized series between 1988 and 1989. Overall 11 were treated by pelvic lavage, 78 by laparotomy and 46 by laparoscopic procedures.

Main outcome measures: Postoperative complications, duration of hospital stay. Cumulative pregnancy rates after the procedures.

Results: The two groups of women analysed in the randomized series were comparable for duration of amenorrhoea, diameter of the ectopic pregnancy and prevalence of 'ruptured' ectopics, but the duration of stay in hospital was much shorter (mean 2.9, SD 1.8 days) for the 34 women treated by laparoscopy than for the 42 women treated by laparotomy (mean 6.8, SD 1.6 days). The postoperative cumulative pregnancy rate was higher in nulliparous women with a history of infertility or pelvic inflammatory disease (PID), when treated with CO2-laser-laparoscopy (P = 0.009). The recurrency rate was low (less than 5% in both groups). Overall in the women treated by laparotomy, postoperative cumulative pregnancy rates were lower following excision or adnexectomy than after a microsurgical linear salpingotomy (P = 0.01). Four women treated by laparoscopy required a second procedure.

Conclusion: Endoscopic treatment of large and/or ruptured ectopic pregnancies is feasible and resulted in a shorter hospital stay and, in nulliparous women with a history of PID or infertility, in higher cumulative pregnancy rates, than after microsurgical salpingotomies.