Laparoscopic salpingostomy for ectopic pregnancy

Seventy-nine ampullary tubal ectopic pregnancies were managed using laparoscopic linear salpingostomy. An incision was made on the antimesenteric side of the fallopian tube, over the point of maximum bulge, with unipolar electrocautery, the argon laser, or CO2 laser. Bleeding was controlled by micropinpoint cautery. After completion of the procedure, the abdomen was lavaged with Ringer's lactate, and 200 mL of Hyscon was placed in the peritoneal cavity. Patients were also treated with doxycycline 100 mg twice daily. There were two major complications, both involving continued bleeding recognized within one hour of the original procedure. One resulted from faulty equipment, and the other was associated with removal of an ectopic pregnancy greater than 3 cm in greatest diameter. All patients were discharged within 24 hours of the procedure. There were no long-term complications. Of 69 patients actively trying to conceive, 43 (62%) conceived. Seven (16%) of the conceptions were repeat ectopic pregnancies, divided between the contralateral and ipsilateral tube. Ten of forty-three (23%) aborted. The viable pregnancy rate of 38% is comparable to that with other techniques. It would appear from our observations that a skilled laparoscopist can remove a small tubal pregnancy in this manner with minimal complications.