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What Is the Effectiveness of Salpingectomy Compared with Salpingotomy in Improving Outcomes in Women with Tubal Ectopic Pregnancy?

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What Is the Effectiveness of Salpingectomy Compared with Salpingotomy in Improving Outcomes in Women with Tubal Ectopic Pregnancy? Ectopic pregnancy and miscarriage What is the effectiveness of salpingectomy compared with salpingotomy in improving outcomes in women with tubal ectopic pregnancy? Study details Participants Interventions Methods Outcomes and Results Comments Full citation Sample size Interventions Details Results Limitations Tahseen,S., Wyldes,M., A N=150 Salpingectomy This is a retrospective study Spontaneous intrauterine Retrospective comparative case- (n=97) carried out in the East pregnancy rate (number/total controlled study of Characteristics Birmingham Hospitals (%)) Not reported whether women laparoscopic vs Salpingotomy (Teaching) NHS Trust, UK. were trying to conceive laparotomy management (n=25) All patients operated on Salpingectomy: 38/97 (39.2) of ectopic pregnancy: an Not reported separately for laparoscopically for EP Salpingotomy: 12/25 (48) Outcome of intrauterine evaluation of reproductive salpingectomy and during the study period were pregnancy is not reported performance after radical salpingotomy groups identified. A control group vs conservative treatment was selected randomly from Unclear how fertility data was of tubal ectopic pregnancy, Inclusion criteria those operated on by obtained Journal of Obstetrics and laparotomy. Hospital case Gynaecology, 23, 189-190, Ectopic pregnancy notes were reviewed for Generally poor methodological 2003 details. An attempt was reporting made to contact all patients Ref Id Exclusion criteria regarding contraceptive use. No baseline characteristics Only one spontaneous IUP reported for salpingectomy vs. 69637 Not reported or EP was included per salpingotomy groups patient in the analysis. Country/ies where the Subsequent fertility was Unexplained missing data from study was carried out analysed in relation to initial 28/150 women treatment method and the UK state of the contralateral Blinding of participants and/or tube. those assessing outcomes is not Study type reported. Retrospective comparative observational study Other information Both laparotomies and Aim of the study laparoscopies were done. Not reported Follow-up was 32.7 months (SD 8.4) in the laparoscopy arm and 556 Ectopic pregnancy and miscarriage Study details Participants Interventions Methods Outcomes and Results Comments Study dates 34.6 months (SD 9.7) in the laparotomy arm. Averages are 1996 to 2000 not reported for salpingectomy/salpingotomy groups. Source of funding Not reported Full citation Sample size Interventions Details Results Limitations Giambelli,E., Candiani,M., N=114 Salpingectomy During the study period, Need for further intervention Retrospective Natale,A., Gruft,L., (n=59) data was gathered from 114 (number/total (%)) De,MarinisS, Sambruni,I., Characteristics consecutive patients Unclear how fertility data was Colombo,P., Busacca,M., Salpingotomy undergoing laparoscopic Salpingectomy: 0/59 (0) obtained Laparoscopic treatment of (n=55) surgery for ectopic Salpingostomy: 4/55 (7.3) ectopic pregnancy: Age/years (average (range)): pregnancy. (Note: 3 received a single 45% loss to follow-up for fertility Analysis of 114 32.3 (21 - 41) (Note: these dose of methotrexate on days outcomes (63/114 were followed consecutive cases, Italian Conservative treatment 7-10; 1 received a laparotomy up) Journal of Gynaecology Gestational procedures are referred to as consisted of a simple, linear, on day 15. One further patient and Obstetrics, 8, 5-9, age/weeks (mean (range)) : longitudinal salpingotomy on showed a very long period of The number of women receiving 1996 7.4 (6 - 13) ablative surgery and conservative the antimesenteric tubal slow decline of hCG but was each type of surgery that desired margin by a thin diathermal monitored to resolution future pregnancy is not reported, Ref Id surgery in some Site of ectopic pregnancy parts of the paper) tip. Enucleation of the without need for a further therefore denominators for future (number/total (%)) trophoblastic tissue was intervention and therefore has pregnancy rates cannot be 77300 performed by a suction- not been included here). calculated. Ampullar: 100/114 (87.7) irrigation instrument. In Country/ies where the Isthmic: 10/114 (8.8) some cases oxitocine had Outcome of intrauterine study was carried out Subsequent intrauterine Cornual: 2/114 (1.8) been previously injected into pregnancy (%) pregnancies is not reported. the tubal wall to help Italy Ovarian: 1/114 (0.9) Peritoneal: 1/114 (0.9) haemostasis and tissue Salpingectomy: 62.5 Baseline characteristics not asportation. No tubal suture reported separately for Study type Salpingostomy: 53.8 Condition of tube, split by was performed after ectopic salpingectomy/salpingostomy treatment type (number/total pregnancy removal. Tissue groups. Retrospective comparative was extracted from the Ectopic pregnancy (%) observational study (%)) abdominal cavity by an Blinding of participants and/or endoscopic bag. Salpingectomy: 5.1 those assessing outcomes is not Unruptured: 103/114 (90.4) Salpingostomy: 7.8 Aim of the study - Conservative: 55/103 (53.3) reported. - Ablative: 48/103 (46.6) Laparoscopic salpingectomy was performed with bipolar All ruptured ectopics received It is unclear what the 557 Ectopic pregnancy and miscarriage Study details Participants Interventions Methods Outcomes and Results Comments To analyse the efficacy of Ruptured: 11/114 (9.6) forceps and scissors denominators are for future radical surgery. laparoscopy in the - Conservative: 0/11 (0) according to the standard pregnancies. However, a total treatment of ectopic - Ablative: 11/11 (100) technique, and the tube was of 22 women had an Other information pregnancy. extracted from the abdomen intrauterine pregnancy and 2 Contralateral tube condition, with an endoscopic bag. women had another ectopic pregnancy, out of a total of 37 All patients received laparoscopy. Study dates split by treatment type (number/total (%)) Both types of intervention women who were followed up were followed by accurate and desired a further January 1993 to October Normal: 84/114 washing of the peritoneal pregnancy. 1995 - Conservative: 44/84 (52.4) cavity and asportation of - Ablative: 40/84 (47.6) blood clots to prevent trophoblastic persistence Source of funding Pathologic: 30/114 (26.3) due to surgical - Conservative: 11/30 (36.7) dissemination. The patients Not reported - Ablative: 19/30 (63.3) were discharged 24-36 hours after laparoscopy. Inclusion criteria Serum hCG was measured before treatment, and it was Treatment for ectopic used as one of the criteria pregnancy by laparoscopy for judging which mode of management to perform and Exclusion criteria its efficacy. Post-treatment blood samples were taken on dats 3, 7 and 14 to Not reported diagnose persistence of trophoblastic tissue. The criteria used to evaluate the treatment were clinical conditions, hCG absolute and serial values, ultrasound, the possible monitoring period, desire for future pregnancy and patient consensus. Acute abdominal pain required urgent surgical treatment using laparoscopy or laparotomy. hCG>3000 also indicated surgery. Values 558 Ectopic pregnancy and miscarriage Study details Participants Interventions Methods Outcomes and Results Comments <1500 led to request for further samples and ultrasound after 24-48 hours to exclude the possibility of intrauterine pregnancy. For other values, expectant, medical or surgical treatment was indicated based on the pattern of change. A counselling session was given to the patient to evaluate her openness to a period of serum hCG monitoring and expectant or medical management acceptability. The choice of salpingectomy or salpingostomy was decided based on tubal conditions, contralateral tubal conditions, patient's age, desire for future pregnancy and other obstetric and gynaecological history (sterility, previous ectopic, PID). All the patients were informed that both kinds of procedures were possible. Persistent ectopic pregnancy was defined as the growth or plateau value of serum hCG after treatment that requires further intervention. 63 patients were followed up for 6 months after surgery, 559 Ectopic pregnancy and miscarriage Study details Participants Interventions Methods Outcomes and Results Comments of which 37 desired pregnancy. Full citation Sample size Interventions Details Results Limitations Parker,J., Permezel,M., N=203 Salpingectomy This study was a Need for further intervention Retrospective Thompson,D., Review of (n=103) retrospective analysis of 203 (number/total (%)) the management of ectopic (This is the total number of consecutive cases of Characteristics of women at pregnancy in a major cases of ectopic pregnancy Salpingostomy ectopic pregnancy treated at Salpingectomy: 1/103 (1.0) baseline are not reported - there teaching hospital: treated during the study (n=50) the Royal Women's Hospital (Note: treated with could have been unreported Laparoscopic surgical period; however 153 were during the study period. 114 methotrexate IMI) differences between the arms. treatment and persistent treated by salpingectomy or of these women had a ectopic pregnancy, salpingostomy, and therefore laparoscopic surgical Salpingostomy: 6/50 (12) Unclear what drove the choice of Australian and New constitute the main procedure. In a further 10 (Note: treated with procedure. Zealand Journal of population of interest for this patients an initial methotrexate IMI (n=2), Obstetrics and review) laparoscopic treatment was laparoscopic salpingectomy Blinding of participants and/or Gynaecology, 34, 575-579, abandoned and a (n=2), laparoscopic those
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