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Laparoscopic management of ectopic pregnancies: a comparison between interstitial and “more distal” tubal pregnancies

  • General Gynecology
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Abstract

Background/aims

Laparoscopy is an established, safe, and feasible management option for tubal pregnancies, even in women with significant hemoperitoneum. In case of interstitial pregnancy, however, a laparoscopic surgical approach is still a matter of debate. The objective of this study is to evaluate the safety and feasibility of a laparoscopic approach to interstitial pregnancies.

Methods

A total of 92 women with ectopic pregnancy who underwent a surgical management from April 2009 to August 2015 were reviewed. Clinical and surgical outcomes of confirmed interstitial pregnancies (n = 10) (IP group) were compared with those of “more distal” tubal pregnancies (n = 79) (TP group).

Results

Although there were no differences between the two groups in gestational age, ß-hCG values were significantly higher in the IP group (p = 0.005). All patients with IP were treated by laparoscopic wedge resection. The rate of surgical complications (p = 0.413) and subsequent MTX treatment (p = 0.531) were not significantly different between groups. Operating room (OR) time (p = 0.007) was higher in the IP than in the TP group. After stratification for the presence of hemoperitoneum this difference remained, with patients in the IP group having longer OR time (p = 0.034) and additionally higher intra-operative blood loss (EBL) (p = 0.013). On the other hand, in the absence of hemoperitoneum no differences between the two groups were observed.

Conclusions

In experienced hands, the laparoscopic management of interstitial pregnancies seems to be as safe and feasible as that of other tubal pregnancies. However, it could be technically more challenging, especially in case of hemoperitoneum.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Inselspital Bern, University of Berne, Effingerstrasse 102, 3010, Berne, Switzerland

    Konstantinos Nirgianakis, Andrea Papadia, Brett McKinnon, Daniele Bolla & Michael D. Mueller

  2. Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico of Modena, 41124, Modena, Italy

    Giovanni Grandi

Authors
  1. Konstantinos Nirgianakis
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  2. Andrea Papadia
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  3. Giovanni Grandi
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  4. Brett McKinnon
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  5. Daniele Bolla
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  6. Michael D. Mueller
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Corresponding author

Correspondence to Konstantinos Nirgianakis.

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Funding

This study was not funded by a grant.

Financial support

There was no financial support to this research.

Conflict of interest

The authors KN, AP, GG, BMc, DB, and MDM declare that they have no conflict of interest.

Ethical standards

All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments. The study was IRB approved (Nr: 295/15).

Informed consent

Since this is a retrospective study no informed consent was obtained from the participants included in the study.

Additional information

The authors consider that the first two authors should be regarded as joint first authors.

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Nirgianakis, K., Papadia, A., Grandi, G. et al. Laparoscopic management of ectopic pregnancies: a comparison between interstitial and “more distal” tubal pregnancies. Arch Gynecol Obstet 295, 95–101 (2017). https://doi.org/10.1007/s00404-016-4191-x

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  • DOI: https://doi.org/10.1007/s00404-016-4191-x

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