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Obstetrics & Gynecology 1989;73:400-404
© 1989 by The American College of Obstetricians and Gynecologists
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Management of Unruptured Ectopic Gestation by Linear Salpingostomy: A Prospective, Randomized Clinical Trial of Laparoscopy Versus Laparotomy

MICHAEL VERMESH, MD, PAUL D. SILVA, MD, GREGORY F. ROSEN, MD, ANDREA L. STEIN, MD, GREGORY T. FOSSUM, MD and MARK V. SAUER, MD

From the Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California

Abstract

This study was designed to compare prospectively the parameters of morbidity, cost, length of hospital stay, and fertility outcome after linear salpingostomy by laparoscopy versus laparotomy. Entry criteria included stable vital signs, hematocrit greater than 30%, age over 18 years, and desire for future fertility. AH patients underwent diagnostic laparoscopy. Sixty patients with unruptured ectopic gestations of 5 cm or smaller were randomized to either laparoscopy (N=30) or laparotomy (N=30). Postoperative follow-up included serial measurements of serum ß-hCG titers at 3-day intervals and hysterosalpingography at 12 weeks. The laparoscopy and laparotomy groups were similar in age, height, weight, gravidity, gestational age, hematocrit, ectopic pregnancy size, and preoperative ß-hCG levels. The estimated blood loss was significantly (P<.001) lower in patients undergoing laparoscopy, and was not affected by vasopressin injection. Two patients in the laparoscopy group required laparotomy for hemostasis, and two patients undergoing laparotomy had wound infection. One patient in each group had persistent trophoblastic activity. Baseline serum ß-hCG levels and the rate and magnitude of postoperative ß-hCG decline were similar in both groups. The length of hospital stay was significantly (P<.001) shorter after laparoscopic salpingostomy (1.4 ± 0.1 days) than after laparotomy (3.3 ± 0.2 days). Postoperative hysterosalpingography showed patency of the involved tube in 16 of 20 (80%) and 17 of 19 (89%) of patients in the laparoscopy and laparotomy groups, respectively. Pregnancy rates were ten of 18 (56%) and 11 of 19 (58%) in these groups, respectively, and all pregnancies were conceived within 6 months of surgery. These data suggest that although these two conservative procedures are similarly safe and effective, laparoscopy is more economical and requires a shorter recovery period.




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