A meta-analysis included 2 RCTs and 8 cohort studies with a total of 1 229 patients. The RCT (n=575) subgroup indicated that there was no statistically significant difference in intrauterine pregnancy (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 study subgroup (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), and 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 (PEP) 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). An IUP would be more likely to occur after salpingotomy than salpingectomy when the follow-up time was more than 36 months (RR 1.16, 95% CI 1.02 to 1.32, P 0.03).
A systematic review 1 including 40 studies with a total of 4 832 subjects (15 non-comparative, retrospective studies including 1 383 patients, 15 comparative, retrospective studies including 2 965 patients, and 10 prospective, selected treatment series including 484 patients) was abstracted in DARE. No randomised controlled trials were found.
Retrospective, non-comparative studies: No statistically significant difference between intrauterine pregnancy rates was found following conservative tubal surgery (46%, 95% CI 41.7 to 51.0) or radical tubal surgery (44%, 95% CI 40.7 to 47.3). Repeat ectopic pregnancy rate was 10% (95% CI 7.8 to 13.6) following conservative surgery and 15% (95% CI 12.8 to 17.5) following radical surgery. The difference was not statistically significant.
Retrospective, comparative studies: Only 1/15 papers showed a significant difference between intrauterine pregnancy rates, and this was in favour of conservative surgery. None of the papers demonstrated a significant difference in repeat ectopic pregnancy rates.
Prospective, uncontrolled series: The average intrauterine pregnancy rate was 57% (95% CI 53.5 to 62.7) after conservative surgery. Only two studies compared conservative and radical surgery, with no difference found. The average repeat pregnancy rate was 13% (95% CI 10.4 to 16.9) after conservative tubal surgery.
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