Skip to main content
SpringerLink
Log in

Current Approach to Surgical Treatment of Ectopic Pregnancy

  • Ectopic Pregnancy (G Sel, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to update readers on recent surgical treatment modalities of ectopic pregnancies (EP) and their advantages vs disadvantages.

Recent Findings

EP was generally managed with surgical treatment, and of the available applications, methotrexate (MTX) may be preferred for selected patients. “Wait-and-see” can be another treatment method, depending on preference or need. Surgical treatment indications are haemodynamic instability, suspected or risk of rupture, contraindications for MTX, or failure of medical treatment.

Summary

Salpingostomy or salpingectomy is generally the first surgical choice in tubal EPs. The selection of salpingostomy or salpingectomy is based on several factors and the decision should be made by the surgeon and patient together. For women who have completed fertility, bilateral salpingectomy can be applied for permanent sterilisation. The sterilisation method of salpingectomy has the additional potential benefit of reducing the risk of tubal neoplasia and ovarian cancer. The advantage of salpingostomy is the potential to preserve the tube to meet the patient’s wishes for potential future fertility. The selection of surgical approach (laparoscopy vs laparotomy) should be made by the surgeon in consultation with the anaesthetist and taking the clinical condition of the patient into account.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as:

    • Of importance

      •• Of major importance

      1. Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 191: tubal ectopic pregnancy. Obstet Gynecol. 2018;131(2):65–77. The majority localization of the ectopic pregnancy is fallopian tube according to current bulletins.

      2. Hawrylyshyn K, McLeod SL, Thomas J, Varner C. Methotrexate for the treatment of unruptured tubal ectopic pregnancy. CJEM. 2019;21(3):391–4.

        Article  CAS  Google Scholar 

      3. Paull C, Robson SJ. Hospital admission and surgical approach to tubal ectopic pregnancy in Australia 2000 to 2014: a population-based study. Aust N Z J Obstet Gynaecol. 2018;58(2):234–8.

        Article  Google Scholar 

      4. Fernandez H, Capmas P, Lucot JP, Resch B, Panel P, Bouyer J 2013 Fertility after ectopic pregnancy: the DEMETER randomized trial Hum Reprod 28 5 1247 1253

      5. Mol F, van Mello NM, Strandell A, Strandell K, Jurkovic D, Ross J, et al. European Surgery in Ectopic Pregnancy (ESEP) study group. Salpingotomy versus salpingectomy in women with tubal pregnancy (ESEP study): an open-label, multicentre, randomised controlled trial. Lancet. 2014;383(9927):1483–9.

      6. Cheng X, Tian X, Yan Z, Jia M, Deng J, Wang Y, et al. Comparison of the fertility outcome of salpingotomy and salpingectomy in women with tubal pregnancy: a systematic review and meta-analysis. PLoS One. 2016;11(3):e0152343.

      7. Gasparri ML, Mueller MD, Taghavi K, Papadia A. Conventional versus single port laparoscopy for the surgical treatment of ectopic pregnancy: a meta-analysis. Gynecol Obstet Invest. 2018;83(4):329–37.

        Article  Google Scholar 

      8. Yang J, Na YJ, Song YJ, Choi OH, Lee SK, Kim HG. The effectiveness of laparoendoscopic single-site surgery (LESS) compared with conventional laparoscopic surgery for ectopic pregnancy with hemoperitoneum. Taiwan J Obstet Gynecol. 2016;55(1):35–9.

        Article  Google Scholar 

      9. Yang J, Kim HG, Song YJ, Yoon G, Na YJ. The effectiveness of laparoendoscopic single-site surgery (LESS) compared with conventional laparoscopic surgery for ectopic pregnancy with hemoperitoneum. J Minim Invasive Gynecol. 2015;22(6S):194.

        Article  Google Scholar 

      10. Bedaiwy MA, Escobar PF, Pinkerton J, Hurd W. Laparoendoscopic single-site salpingectomy in isthmic and ampullary ectopic pregnancy: preliminary report and technique. J Minim Invasive Gynecol. 2011;18(2):230–3.

        Article  Google Scholar 

      11. Kim YW, Park BJ, Kim TE, Ro DY. Single-port laparoscopic salpingectomy for surgical treatment of tubal pregnancy: comparison with multi-port laparoscopic salpingectomy. Int J Med Sci. 2013;10(8):1073–8.

        Article  Google Scholar 

      12. Kim MK, Kim JJ, Choi JS, Eom JM, Lee JH. Prospective comparison of single port versus conventional laparoscopic surgery for ectopic pregnancy. J Obstet Gynaecol Res. 2015;41(4):590–5.

        Article  Google Scholar 

      13. Yoon BS, Park H, Seong SJ, Park CT, Jun HS, Kim IH. Single-port versus conventional laparoscopic salpingectomy in tubal pregnancy: a comparison of surgical outcomes. Eur J Obstet Gynecol Reprod Biol. 2011;159(1):190–3.

        Article  Google Scholar 

      14. Ting WH, Lin HH, Hsiao SM. Factors predicting persistent ectopic pregnancy after laparoscopic salpingostomy or salpingotomy for tubal pregnancy: a retrospective cohort study. J Minim Invasive Gynecol. 2019;26(6):1036–43. Persistent Ectopic Pregnancy due to the type of surgery.

      15. Ozcan MCH, Wilson JR, Frishman GN. A systematic review and meta-analysis of surgical treatment of ectopic pregnancy with salpingectomy versus salpingostomy. J Minim Invasive Gynecol. 2021;28(3):656–67.

        Article  Google Scholar 

      16. Petrini A, Spandorfer S. Recurrent ectopic pregnancy: current perspectives. Int J Womens Health. 2020;12:597–600.

        Article  Google Scholar 

      17. Spandorfer SD, Sawin SW, Benjamin I, Barnhart KT. Postoperative day 1 serum human chorionic gonadotropin level as a predictor of persistent ectopic pregnancy after conservative surgical management. Fertil Steril. 1997;68(3):430–4.

        Article  CAS  Google Scholar 

      18. Zhang Y, Chen J, Lu W, Li B, Du G, Wan X. Clinical characteristics of persistent ectopic pregnancy after salpingostomy and influence on ongoing pregnancy. J Obstet Gynaecol Res. 2017;43(3):564–70.

        Article  Google Scholar 

      19. Ego A, Subtil D, Cosson M, Legoueff F, Houfflin-Debarge V, Querleu D. Survival analysis of fertility after ectopic pregnancy. Fertil Steril. 2001;75(3):560–6.

        Article  CAS  Google Scholar 

      20. Gervaise A, Masson L, de Tayrac R, Frydman R, Fernandez H. Reproductive outcome after methotrexate treatment of tubal pregnancies. Fertil Steril. 2004;82(2):304–8.

        Article  Google Scholar 

      21. Egger E. Recurrent interstitial pregnancy: a review of the literature. Geburtshilfe Frauenheilkd. 2017;77(4):335–9.

        Article  Google Scholar 

      22. Chen L, Zhu D, Wu Q, Yu Y. Fertility outcomes after laparoscopic salpingectomy or salpingotomy for tubal ectopic pregnancy: a retrospective cohort study of 95 patients. Int J Surg. 2017;48:59–63.

        Article  Google Scholar 

      23. Baggio S, Garzon S, Russo A, Ianniciello CQ, Santi L, Laganà AS, et al. Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant management. Arch Gynecol Obstet. 2021;303(1):259–68.

        Article  CAS  Google Scholar 

      24. Lou T, Gao Y, Feng Y, Lu J, Zhang Z, Bai H. Reproductive outcomes of cesarean scar pregnancies pretreated with methotrexate and uterine artery embolization prior to curettage. Taiwan J Obstet Gynecol. 2020;59(3):381–6.

        Article  Google Scholar 

      25. Karavani G, Gutman-Ido E, Herzberg S, Chill HH, Cohen A, Dior UP. Recurrent tubal ectopic pregnancy management and the risk of a third ectopic pregnancy. J Minim Invasive Gynecol. 2020;11:1553–4650(20)31172–9.

      26. Chouinard M, Mayrand MH, Ayoub A, Healy-Profitós J, Auger N. Ectopic pregnancy and outcomes of future intrauterine pregnancy. Fertil Steril. 2019;112(1):112–9.

        Article  Google Scholar 

      27. Wang X, Huang L, Yu Y, Xu S, Lai Y, Zeng W. Risk factors and clinical characteristics of recurrent ectopic pregnancy: a case-control study. J Obstet Gynaecol Res. 2020;46(7):1098–103.

        Article  Google Scholar 

      28. Dagar M, Srivastava M, Ganguli I, Bhardwaj P, Sharma N, Chawla D. Interstitial and cornual ectopic pregnancy: conservative surgical and medical management. J Obstet Gynaecol India. 2018;68(6):471–6.

        Article  Google Scholar 

      29. Gao MY, Zhu H, Zheng FY. Interstitial pregnancy after ipsilateral salpingectomy: analysis of 46 cases and a literature review. J Minim Invasive Gynecol. 2020;27(3):613–7.

        Article  Google Scholar 

      30. Jiang LY, Wang PH. Interstitial pregnancy: cornuostomy or wedge resection? J Chin Med Assoc. 2019;82(3):167–8.

        Article  Google Scholar 

      31. Piecha D, Pluta D, Pas P, Plonka J, Kowalczyk K. Interstitial ectopic pregnancy following ipsilateral salpingectomy. Ginekol Pol. 2020;91(8):478–9.

        Article  Google Scholar 

      32. Eichbaum M, Asrar H, Klee A, Eichbaum C. Laparoscopic treatment of an interstitial ectopic pregnancy. J Minim Invasive Gynecol. 2020;S1553–4650(20):31183–93.

        Google Scholar 

      33. Chen PL, Lin HH, Hsiao SM. Predictors of subsequent pregnancy in women who underwent laparoscopic cornuostomy or laparoscopic wedge resection for interstitial pregnancy. J Chin Med Assoc. 2019;82(2):138–42.

        Article  Google Scholar 

      34. Lee MH, Im SY, Kim MK, Shin SY, Park WI. Comparison of laparoscopic cornual resection and cornuotomy for interstitial pregnancy. J Minim Invasive Gynecol. 2017;24(3):397–401.

        Article  Google Scholar 

      35. Procas-Ramon B, Gabasa-Gorgas L, Ruiz-Martinez S, Perez-Muñoz A, Sobreviela-Laserrada M. Hysteroscopic management of an interstitial ectopic pregnancy. J Minim Invasive Gynecol. 2019;26(6):1000–1.

        Article  Google Scholar 

      36. Lin YH, Huang LW, Hwang JL, Yang IF, Huang TC. Hysteroscopic diagnosis of an intrauterine pregnancy mimicking an interstitial pregnancy on ultrasound. J Obstet Gynaecol. 2019;4:1–2.

        Google Scholar 

      Download references

      Author information

      Authors and Affiliations

      1. Gynecology and Obstetrics Department, Amasya University Sabuncuoglu Serefeddin Training and Research Hospital, Amasya, 05000, Turkey

        Banuhan Şahin

      2. Gynecology and Obstetrics Clinics, Turhal State Hospital, Tokat, Turkey

        Buğra Şahin

      Authors
      1. Banuhan Şahin
        View author publications

        You can also search for this author in PubMed Google Scholar

      2. Buğra Şahin
        View author publications

        You can also search for this author in PubMed Google Scholar

      Corresponding author

      Correspondence to Banuhan Şahin.

      Ethics declarations

      Conflict of Interest

      Authors declared none.

      Human and Animal Rights and Informed Consent

      This article does not contain any studies with human or animal subjects performed by any of the authors.

      Additional information

      Publisher's Note

      Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

      This article is part of the Topical Collection on Ectopic Pregnancy

      Rights and permissions

      Reprints and permissions

      About this article

      Check for updates. Verify currency and authenticity via CrossMark

      Cite this article

      Şahin, B., Şahin, B. Current Approach to Surgical Treatment of Ectopic Pregnancy. Curr Obstet Gynecol Rep 10, 101–106 (2021). https://doi.org/10.1007/s13669-021-00308-1

      Download citation

      • Accepted:

      • Published:

      • Issue Date:

      • DOI: https://doi.org/10.1007/s13669-021-00308-1

      Keywords

      Search

      Navigation