Laparoscopic Salpingotomy Versus Salpingectomy for Tubal Pregnancy

Comment: The quality of evidence is downgraded by study limitations (lack of blinding in half of the studies).

A systematic review and meta-analysis 3 included 24 RCTs with a total of 2 354 patients. The natural intrauterine pregnancy rate after laparoscopic salpingotomy was significantly higher than those who underwent salpingectomy (OR 2.49; 95%CI 1.61 to 3.86; 15 trials, n=826; p < 0.0001, I²=75%). The volume of intraoperative blood loss was less in salpingotomy than that in salpingectomy (WMD −164.86; 95%CI −195.3 to -134.34; 11 trials, n=948; p < 0.00001, I²=88%). In addition, laparoscopic salpingotomy better protected the ovarian reserve function and endocrine function.

Another systematic review and meta-analysis 4 included 2 RCTs and 16 cohort studies in low risk patients. In the RCTs, there was no significant difference in the odds of subsequent intrauterine pregnancy (OR 0.97; 95% CI 0.71 to 1.33). However, a significant and clinically meaningful difference was noted in the cohort studies, with the patients having a lower chance of intrauterine pregnancy after salpingectomy (OR 0.45; 95% CI 0.39 to 0.52). No significant difference was noted in the OR for a repeat ectopic pregnancy in the randomized trials, but in the cohort studies patiens had a cumulatively higher risk of repeat ectopic pregnancy after a salpingostomy.

A meta-analysis 2 included 2 RCTs and 8 cohort studies with a total of 1 229 patients. In the RCTs (n=575) there was no statistically significant difference in IUP rates (RR 1.04, 95% CI 0.89 to 1.21, P 0.61) nor the repeat ectopic pregnancy (REP) rate (RR .30, 95% CI 0.72 to 2.38, P 0.39) between the salpingotomy and salpingectomy group. In contrast, in the cohort studies (n=654) the IUP rate was higher in the salpingotomy group compared with the salpingectomy group (RR 1.24, 95% CI 1.08 to 1.42, P 0.002), but salpingotomy also increased the risk of REP rate (RR 2.27, 95% CI 1.12 to 4.58, P 0.02). The persistent ectopic pregnancy occurred more frequently in the salpingotomy group than the salpingectomy group (RR 11.61, 95% CI 3.17 to 42.46, P 0.0002, n=932).

References

• Cheng X, Tian X, Yan Z et al. Comparison of the Fertility Outcome of Salpingotomy and Salpingectomy in Women with Tubal Pregnancy: A Systematic Review and Meta-Analysis. PLoS One 2016;11(3):e0152343. [PubMed]
• Wenjing L, Haibo L. Therapeutic effect of laparoscopic salpingotomy vs. salpingectomy on patients with ectopic pregnancy: A systematic review and meta-analysis. Front Surg 2022;9():997490. [PubMed]
• Ozcan MCH, Wilson JR, Frishman GN. A Systematic Review and Meta-analysis of Surgical Treatment of Ectopic Pregnancy with Salpingectomy versus Salpingostomy. J Minim Invasive Gynecol 2021;28(3):656-667. [PubMed]