Is there Still a Place for Laparotomy in the Management of Tubal Ectopic Pregnancy?
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- Category: Vol. 81, December 2013
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Is there Still a Place for Laparotomy in the Management of Tubal Ectopic Pregnancy?, AHMED M.M.K. NOOH
Abstract
Background: Due to the perceived advantages of laparos-copy over laparotomy, the last two decades have witnessed an enormous increase in the number of tubal ectopic pregnan-cies which were managed successfully laparoscopically to the point that the role of laparotomy in the management of this condition might have become questionable.
Objective: To investigate whether there is still a role for laparotomy in the management of tubal ectopic pregnancy and, if any, to what extent?.
Subjects and Methods: Fifty women were treated surgically for tubal ectopic pregnancy over 14 months at a university-affiliated British hospital. Out of these cases, 24 (48%) had a laparotomy and these constituted the subjects of this study. Case notes were reviewed and patients’ data were collected. These were analysed mainly for the indications of laparotomy and capacity of operator.
Results: The most common indication for laparotomy was haemodynamic instability. Only one laparotomy was performed by a consultant, another one by a senior resident (year 4-5) and the remaining 22 by junior residents (year 1-3). The consultant, senior resident and only one junior resident have had adequate operative laparoscopic experience. Nineteen cases (38%) could have avoided laparotomy had they been managed by a surgeon with adequate operative laparoscopic experience. This leaves only 5 cases (10%) in which laparot-omy was unavoidable.
Conclusion: A certain percentage (10% in this study) of all tubal ectopic pregnancy would eventually have a laparot-omy. The main indication for unavoidable laparotomy is haemodynamic instability. Other reasons include extensive pelvic adhesions and history of multiple pelvic/abdominal surgeries.