Laparoscopic management of ectopic pregnancies: a comparison between interstitial and "more distal" tubal pregnancies.

Abstract

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. 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). 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. 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.