Ist eine Nahtversorgung der linearen Salpingotomie zur tubenerhaltenden Operation der Tubargravidität notwendig? - Eine experimentell chirurgische Untersuchung am Schwein

Abstract

Objective: Today longitudinal salpingotomy is considered the appropriate operative minimal-invasive procedure for unruptured tubal pregnancies. It remains unclear whether primary surgical closure of the salpingotomy is better than secondary wound healing. Material and Methods: 15 mini-pigs underwent minimal invasive surgery with linear uterotomy as a homologous regimen to simulate linear salpingotomy. 5 cuts of 1, 2 and 3 cm respectively were carried out at the ipsi- and contralateral horn of the uterus antimesotubar. The ipsilateral cuts were left open while the contralateral cuts were sutured primarily. Results: The cuts with a length of 1 cm had a very high rate of primary wound healing without any correlation to the primary surgical closure. Tubal integrity, adhesion rates and fistula showed similar results irrespective of whether primary suturing was done or the cuts were left open without any further surgical closure. In the cases of cuts of 2 and 3 cm there was a higher rate of fistula if the cuts were left open. Suturing reduced this rate. Conclusion: In cases of salpingotomies of 1 cm or less no further wound suturing is necessary. These cases show a high rate of primary wound closure with a very low rate of fistula and occlusion of the fallopian tubes. If the salpingotomy is larger or equivalent to 2 cm, suturing of the wound is needed to reduce the rate of fistulas of the fallopian tube.