Beyond Guidelines: Effectiveness of a Programme in Achieving Operative Laparoscopy for all Women Requiring Surgical Management of Ectopic Pregnancy

Odejinmi, Funlayo; Rizzuto, Ivana; Oliver, Reeba; Alalade, Aderemi; Agarwal, Nidheesh; Olowu, O.

doi:10.1159/000371763

Cited by 13 publications

(8 citation statements)

References 29 publications

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“…Dedicated skills training and continuous efforts in promoting laparoscopic surgery are required to ensure that the majority of women with REP are treated laparoscopically, regardless of haemodynamic stability. [18] The benefits to women are so overwhelming that these measures should be implemented. Although haemodynamically unstable patients were excluded from this study, there is enough evidence to suggest that laparoscopic surgery can be safely performed in these women.…”

Section: Resultsmentioning

confidence: 99%

A randomised trial comparing laparoscopy with laparotomy in the management of women with ruptured ectopic pregnancy

2017

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Background. Ruptured ectopic pregnancy (REP) is a common gynaecological emergency in resource-poor settings, where laparotomy is the standard treatment despite laparoscopic surgery being regarded as the optimal treatment. There is a lack of prospective randomised data comparing laparoscopic surgery with laparotomy in the surgical management of women with REP. Objective. To compare operative laparoscopy with laparotomy in women with REP. Methods. This was a randomised parallel study. One hundred and forty women with suspected REP were randomised to undergo operative laparoscopy or laparotomy. The outcome measures were operating time, hospital stay, pain scores and analgesic requirements, blood transfusion, time to return to work, and time to full recovery. Results. Operating time was significantly longer in the laparoscopy group (67.3 v. 30.5 minutes, p<0.001). Duration of hospital stay, pain scores and need for analgesia were significantly less in the laparoscopy group. Women in this group returned to work 8 days earlier and their time to full recovery was significantly shorter compared with those in the laparotomy group. Significantly more women undergoing laparotomy required blood transfusion than women in the laparoscopy group. In the latter group, 14.5% of women required blood transfusion compared with 26.5% in the laparotomy group (p=0.01). Conclusion. Operative laparoscopy in women treated for REP is feasible in a resource-poor setting and is associated with significantly less morbidity and a quicker return to economic activity.

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Section: Resultsmentioning

confidence: 99%

A randomised trial comparing laparoscopy with laparotomy in the management of women with ruptured ectopic pregnancy

2017

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“…In comparison to laparotomy, laparoscopic surgery with gasless abdominal wall-lifting [2] or pneumoperitoneum [1,4,5] is considered to be a less invasive option for the management of ectopic pregnancy. Furthermore, with recent advances in techniques, LESS surgery has been suggested as a feasible and preferable alternative to conventional multi-port laparoscopy [8,[10][11][12], because of its potential advantages, which include easy anatomical access to the pelvic cavity through a single umbilical skin incision, a safer approach to the abdominal cavity by an open procedure, especially in patients with a Table 3 The surgical outcomes of ectopic pregnancies with significant hemoperitoneum ≥ 800 mL, including 16 cases managed by gasless laparoendoscopic single-site surgery and 2 cases managed by conversion to multi-port laparoscopic surgery history of previous abdominal surgery, and cosmetic results obtained as the procedure involves a single surgical wound limited to the umbilicus [8,[10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…With advances in diagnostic and therapeutic modalities, earlier detection of ectopic pregnancy with minimal symptoms becomes more common [1]. However, if diagnostic delay occurs, significant hemoperitoneum associated with ectopic pregnancy is still a potentially life-threatening condition [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally, such morbidities have usually been managed by laparotomy, occasionally with homologous blood transfusion if necessary [3]. Along with progress in laparoscopic surgical techniques and expertise, improvement in perioperative management of hemodynamic condition by anesthesiologists has facilitated minimally invasive surgical management by laparoscopy for women experiencing hemodynamic instability due to ectopic pregnancy even with massive hemoperitoneum [1,2,4,5].…”

Section: Introductionmentioning

confidence: 99%

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Gasless laparoendoscopic single-site surgery with intraoperative autologous blood transfusion for management of ectopic pregnancy with significant hemoperitoneum: a retrospective observational study

et al. 2019

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Background: With advances in diagnostic and therapeutic modalities, earlier detection of ectopic pregnancy with minimal symptoms makes laparoscopic management more common. However, if diagnostic delay occurs, significant hemoperitoneum associated with ectopic pregnancy is still a potentially life-threatening condition, which presents a therapeutic challenge especially when minimally invasive surgical approach is a significant concern. Herein, retrospective observational study in 18 consecutive cases of ectopic pregnancy with significant hemoperitoneum ≥ 800 mL was performed to assess the feasibility and efficacy of gasless laparoendoscopic single-site (LESS) surgery with intraoperative autologous blood cell salvage and donation for management. Results: At triage, median shock index was 0.95, median hemoglobin value was 6.5 g/dL, and median serum β-hCG value was 13,651 U/L. Surgical diagnosis included 7 ampullary (including 5 abortions and 2 ruptures), 5 ruptured isthmic (including 1 heterotopic pregnancy in remnant tube after salpingectomy and 1 remnant tube pregnancy after salpingo-oophorectomy), 4 ruptured interstitial (including 1 case after salpingectomy), and 2 ruptured ovarian pregnancies. Among these cases, 16 cases were successfully managed by LESS surgery, while, in 2 cases with interstitial pregnancy, conversion to multi-port laparoscopic surgery along with transfusion of bank blood were required. Laparotomic conversion was not experienced. Surgical procedures in 16 cases successfully completed by LESS surgery with intraoperative autologous blood transfusion included unilateral salpingectomy for 7 ampullary and 5 isthmic pregnancies, cornuotomy and cornual resection for each 1 case with interstitial pregnancy, and unilateral salpingooophorectomy and partial ovarian resection for each 1 case with ovarian pregnancy. Median surgical duration was 57.5 min, median amounts of salvaged peritoneal blood were 950 mL (range 800-2000 mL), and median amounts of transfused autologous blood were 540 mL (range 450-1300 mL). Major complications associated with LESS surgery and intraoperative autologous blood transfusion were not experienced. Conclusion: Gasless LESS surgery with intraoperative autologous blood transfusion is a feasible minimally invasive surgical option with avoidance to use homologous blood for management of selected cases of ectopic pregnancy even with significant hemoperitoneum.

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“…Before deciding the final surgical treatment of the affected tube, the opposite tube and ovary should be examined and the procedure should be then taken account of the patient's age and future reproductive capacity as well as the nature of lesion 2 . Laparotomy followed by salpingectomy of the affected side has been a standard modality of treatment of ruptured ectopic pregnancy for many years 3 . Now a day conservative surgery with the preservation of the fallopian tube like linear salpingostomy, linear salpingotomy, segmental resection and end to end anastomosis may be indicated in haemodynamically stable patient with an unruptured tubal ectopic pregnancy who wishes to preserve fertility 4 .…”

Section: Introductionmentioning

confidence: 99%

Surgical Management and Per-operative Findings of Women with Ectopic Pregnancy

Fatema

Ferdosh²,

Munira³

et al. 2020

J Curr Adv Med Res

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Background: Management of ectopic pregnancy is very crucial issue for the survival of the patients. Objective: The purpose of the present study was to observe the surgical management and per-operative findings of women with ectopic pregnancy. Methodology: This cross-sectional study was carried out in the inpatient Department of Obstetrics and Gynaecology at Bangladesh Medical College Hospital, Dhaka, Bangladesh from January 2009 to December 2009 for a period of one (1) year. All clinically suspected cases of ectopic pregnancy within the reproductive age admitted in the department of Obstetrics and Gynaecology at the Bangladesh Medical College Hospital, Dhaka were included in the present study. In most of the cases, laparoscopy or laparotomy was done to confirm the diagnosis and manage the cases. Result: A total number of 48 cases of ectopic pregnancy women were recruited for this study. The highest number of ectopic pregnancy occurs in the ampulla of the fallopian tube which was 27(58.3%) cases. The right tube had been found to be affected more than the left which was 30(62.5%) cases and 18(37.5%) cases respectively. Most of the patients were presented with ruptured tubal pregnancy which was 30(62.5%) cases. Opposite tube was normal looking in 25(52.1%) cases. Unilateral salpingectomy and salpingectomy with contra lateral tubectomy were operated in 32(66.7%) cases and 10(20.8%) cases respectively. Conclusion: In conclusion most of the ectopic pregnancy is occurred in the site of ampulla of fallopian tube in right side which are mostly surgically managed by unilateral salpingectomy. Journal of Current and Advance Medical Research 2020;7(1): 12-16

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Beyond Guidelines: Effectiveness of a Programme in Achieving Operative Laparoscopy for all Women Requiring Surgical Management of Ectopic Pregnancy

Cited by 13 publications

References 29 publications

A randomised trial comparing laparoscopy with laparotomy in the management of women with ruptured ectopic pregnancy

A randomised trial comparing laparoscopy with laparotomy in the management of women with ruptured ectopic pregnancy

Gasless laparoendoscopic single-site surgery with intraoperative autologous blood transfusion for management of ectopic pregnancy with significant hemoperitoneum: a retrospective observational study

Surgical Management and Per-operative Findings of Women with Ectopic Pregnancy

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