Use of Laparoscopic Slip Knot with Purse-String Suture in Surgical Management of Unruptured Heterotopic Interstitial Pregnancies

Abstract

The aim of this study was to investigate the advantages and disadvantages of using laparoscopic slip knot with purse-string suture technique in the surgical management of unruptured heterotopic interstitial pregnancies compared with other surgical strategies. Material/Methods:We retrospectively analyzed data on 13 patients with unruptured heterotopic interstitial pregnancies who underwent laparoscopy in our hospital between May 2012 and August 2018. The control group consisted of 10 patients who underwent cornual resection or cornuostomy with conventional sutures and knots. The study group consisted of 3 patients whose surgical plans involved use of the slip knot with purse-string suture technique followed by cornuostomy. We evaluated the surgical records and video to comparatively analyze their operation duration, intraoperative blood loss, and pregnancy outcomes. Results:The average volume of intraoperative blood loss was 76.67±25 ml in the study group and 215.00±110 ml in the control group. On average, the intraoperative blood loss volume in the study group was 138 ml less than in the control group and the difference was statistically significant (P<0.05). There was no statistically significant difference in the live birth rate and operation time between the 2 groups (P>0.05). The duration of hemostasis in the study group was 11 min shorter than in the control group, while the duration of cornual electrocoagulation in the study group was 18.5 s shorter. Both groups achieved thorough hemostasis without the help of vasopressin and avoided use of embryo-killing drugs such as methotrexate. Neither group required second surgery or developed postoperative complications such as uterus rupture or persistent ectopic pregnancy. Conclusions:This strategy is safe and reliable for gestational sac clearance while simultaneously preventing any potential harm to the intrauterine embryo. It is particularly suitable for unruptured HIP patients who have a strong desire to preserve their intrauterine embryos.

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

“…To the best of our knowledge, this was the first case that maintained tubal patency and protected reproductive function. To date, conservative treatment with multiple doses and/or topical MTX has become the standard of care for IP; however, systemic MTX is contraindicated in the presence of IUP [ 6 , 51 , 52 ] because high doses of MTX may cause fetal congenital bone deformity or IUP miscarriage [ 53 ]. Nevertheless, low-dose MTX treatment has been shown to have no effect on coexisting IUP [ 29 ].…”

Laparoscopic Management of Unruptured Interstitial Pregnancy Using Purse-string Suture Technique

“…Interstitial pregnancy is an ectopic pregnancy wherein the gestational sac is implanted at the interstitial portion of the tubal segment that traverses the muscular wall of the uterus. [ 1 2 3 4 ] These occur in approximately 2% of ectopic pregnancies but are associated with a high rate of morbidity due to the proximity of the gestational sac to the intramyometrial arcuate vasculature. Interstitial pregnancies rupture at an advanced gestation due to the distensibility of the surrounding myometrium, often leading to catastrophic hemorrhage.…”