LAPAROSCOPIC DIRECTED MINILAPAROTOMY FOR THE MANAGEMENT OF DISTURBED ECTOPIC PREGNANCY. IS IT WORTHY?

Design: A comparative clinical trial. Study objective: To compare the efficacy, appropriateness and cost effectiveness of salpingectomy carried out by Japaroscopic directed minilaparotomy for the management of disturbed ectopic pregnancy in haernodynamically stable patients, with Laparoscopic salpingectomy carried out by triple-loop technique and that hy bipolar electrosurgical technique.
Setting: Operative endoscopy unit in Mansoura University Hospitals from June 2002 till March 2004.
Subjects: 48 women with clinical suspicion of disturbed ectopic pregnancy confirmed by ~HCG and transvaginal
ultrasound scan (TVS). All patients were haernodynarnically stable.
Intervention: All cases were subjected to initial laparoscopic evaluation. 2 Cases were excluded; one converted to
laparotomy being istrnic pregnancy and the other one was secured totally by laparoscopy being fimbrial pregnancy. The
remaining 46 women with confirmed ampullary pregnancy were subjected to laparoscopic management as follows; 13
cases underwent laparoscopic salpingectomy carried out by triple - loop technique, I I cases by hipolar c1ectrosurgical
technique and the remaining 22 cases by laparoscopic directed minilaparotomy.
Results: Salpingectomy carried out by laparoscopic directed minilaparotomy was compared with the other 2 groups
(triple-loop technique and bipolar elcctrosurgical technique) concerning its surgical feasibility, operative time, safety,
cost effectiveness, analgesia requirements, recovery time/ return to normal and cosmetic results.
Salpingectomy carried out by Iaparoscopic directed rninilaparotorny enjoys all the advantages of minimally invasive
surgery including good cosmetic results, reduced postoperative analgesia requirements and a quicker return of patients
to their normal activities. With respect to these, it competes favourably with both laparoscopic salpingectomy by
triple-loop technique and bipolar electrosurgical one. However, it is more cost effective than the former and more safer
than the latter. Also, training of surgeons and acquisition of the necessary skills takes shorter than for the other
techniques.
Conclusion : Salpingectomy carried out by laparoscopic directed mini laparotomy for the management of disturbed
ectopic ampullary pregnancy in haemodynamically stable patients is a simple. safe, versatile and cost effective
technique. It may be of benefit and could be offered as an alternative option in circumstances with limited resources and
when electrosurgery is not preferred or the c1ectrosurgical unit is out of function.