Fertility outcomes after laparoscopic salpingectomy or salpingotomy for tubal ectopic pregnancy: A retrospective cohort study of 95 patients

Chen, Lifeng; Zhu, Danpeng; Wu, Qing; Yu, Yan

doi:10.1016/j.ijsu.2017.09.058

Cited by 16 publications

(25 citation statements)

References 23 publications

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“…About surgery, we did not find any significant difference in reproductive outcomes between the different surgical techniques (salpingectomy, salpingostomy and tubal milking), according to some previous studies [ 7 , 30 ]. Nevertheless, our results are limited by the high proportion of patients underwent salpingectomy (94.1%), which limits the cases managed with other approaches and the related study power to show a difference.…”

Section: Discussionsupporting

confidence: 59%

“…Nevertheless, our results are limited by the high proportion of patients underwent salpingectomy (94.1%), which limits the cases managed with other approaches and the related study power to show a difference. The high proportion of patients managed by salpingectomy was because it is the treatment of choice at our Institution; indeed, other studies clearly reported a lower rate of recurrence with no significant difference in future fertility after salpingectomy as compared to salpingotomy [ 7 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 89%

“…There were three options for surgical treatment: tubal or fimbriae milking, salpingotomy, and salpingectomy. Salpingectomy was the treatment of choice at our Institution, due to the reported lower rate of recurrence with no significant difference in future fertility compared to salpingotomy [ 7 , 18 , 19 ]. To evaluate fertility outcomes, we considered only the final treatment.…”

Section: Methodsmentioning

confidence: 99%

“…With the development of laparoscopic techniques, rapid and mini-invasive intervention is quite always possible [ 6 ], which may be radical, by the removal of the entire fallopian tube (salpingectomy), or conservative, with the only removal of the products of gestation from the tube by salpingotomy or tubal milking [ 7 , 8 ]. Non-surgical treatments of EP include expectant management and intramuscular or intravenous Methotrexate (MTX) injection, which avoid the potential complications of surgery.…”

Section: Introductionmentioning

confidence: 99%

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Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant management

Baggio

Garzon

Russo

et al. 2020

Arch Gynecol Obstet

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Purpose To compare fertility and reproductive outcome after surgical, medical, and expectant management for tubal ectopic pregnancy (EP). Methods 133 of 228 patients, who were managed between January 2012 and December 2017 for a tubal EP, tried to conceive immediately after treatment: 86 out of 173 (49.7%) underwent surgical treatment; 38 (21.9%) were treated with methotrexate (MTX), and 49 (28.3%) had expectant management. Clinical data were retrieved by medical records, fertility outcomes were obtained by phone follow-up. The cumulative incidence (CI) of intrauterine clinical pregnancy (CP), miscarriage, live birth (LB), and recurrent EP, and the time between treatment and first intrauterine CP were compared between women treated with MTX, surgery and expectant management. Results The CI of intrauterine CP starting from 12 months after the EP was 65.3% for the expectant management, 55.3% for the MTX group, and 39.5% for surgery (p = 0.012). Post-hoc analysis showed expectant management having higher intrauterine CP and LB, and shorter time between treatment and first intrauterine CP compared to surgery (p < 0.05). The CI of recurrent EP was comparable between the 3 groups. The analysis stratified per βhCG cut-off of 1745 mUI/mL and EP mass cut-off of 25 mm reported consistent results. Conclusions Women successfully managed by expectation appear to have better reproductive outcomes compared to women who underwent surgery, with the shortest time to achieve a subsequent intrauterine CP. Therefore, if safely applicable the expectant management should be considered in the case of tubal EP. The fact that the chosen treatment was primarily guided by the βhCG value and EP mass diameter based on the protocol, which is intrinsically related to the characteristics of the EP, represents the main limitation of the present study. Indeed, we cannot completely exclude that the observed differences between treatments are related to the EP itself instead of the treatment.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant management

Baggio

Garzon

Russo

et al. 2020

Arch Gynecol Obstet

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“…In some rare or complex cases, bilateral salpingectomy should be considered. In addition, Chen et al [19] and Cheng et al [20] showed that there is no statistical difference in long-term reproductive outcomes between the two surgical options. After surgical treatment of the tube, a serum ß-HCG based control is necessary.…”

Section: Commentsmentioning

confidence: 99%

Efficacy and safety of laparoscopy versus local injection with absolute ethanol in the management of tubal ectopic pregnancy

She

Tian

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective To compare the efficacy and safety between laparoscopy and local injection with absolute ethanol (AE) for treating tubal ectopic pregnancy (EP). Study design Retrospective cohort study of ectopic pregnancies in the fallopian tube from two tertiary hospitals between January 2015 and December 2017. Clinical information such as presenting symptoms, reproductive history, possible risk factors, initial diagnosis, serum beta-human chor-ionic gonadotropin (β-HCG) level, transvaginal ultrasonography findings, methods of treatment and outcomes were reviewed and analyzed. Results A total of 119 patients were identified for this study. The diagnosis was based on clinical manifestations, ultrasonography scan and dynamic serum β-HCG. 71.4% of women (85/119) had at least one risk factor for ectopic pregnancy, with the most common risk factors being a history of induced labor, uterine curettage, spontaneous abortion or tubal pregnancy. 64 patients were managed by laparoscopic surgery (Group A) and 2 subjects were failure and followed by a systemic methotrexate (MTX) prescription. The other 55 patients had local injection with absolute ethanol, of which 9 cases failed, followed by a second local injection and intramuscular MTX. The HCG decrease rate post absolute ethanol injection was a value predictive factor for prognosis. Moreover, the pregnancy rate one-year post treatment in local injection subjects (10/55, 18.2%) was higher than that of surgical subjects (5/64, 7.8%). Conclusion Local injection of absolute ethanol and laparoscopic surgery for tubal ectopic pregnancy are both effective and relatively safe, but laparoscopic surgery has better efficacy and shorten hospitalization day. Local injection may be less invasiveness and thus beneficial to fertility preservation.

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Predictive value of serum β-human chorionic gonadotropin for early pregnancy outcomes

Wang

Gao

Zhang

et al. 2019

Arch Gynecol Obstet

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Fertility outcomes after laparoscopic salpingectomy or salpingotomy for tubal ectopic pregnancy: A retrospective cohort study of 95 patients

Cited by 16 publications

References 23 publications

Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant management

Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant management

Efficacy and safety of laparoscopy versus local injection with absolute ethanol in the management of tubal ectopic pregnancy

Predictive value of serum β-human chorionic gonadotropin for early pregnancy outcomes

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