Comparison of the Fertility Outcome of Salpingotomy and Salpingectomy in Women with Tubal Pregnancy: A Systematic Review and Meta-Analysis

Abstract

ObjectiveTo compare the natural fertility outcomes of salpingotomy and salpingectomy among women treated for tubal pregnancy.MethodsAn online database search including PubMed, Embase, CENTRAL and Web of Science was performed to identify studies comparing salpingotomy and salpingectomy to treat women with tubal pregnancy. The search included papers published after the databases were established until May 2015. Two reviewers independently screened literature according to the inclusion and exclusion criteria and then extracted data and assessed the methodological quality of all of the included studies. The meta-analysis was conducted using RevMan 5.3 software. The registration number is CRD42015017545 in PROSPERO.ResultsTwo randomized controlled trials (RCTs) and eight cohort studies, including a total of 1,229 patients, were znalyzed. The meta-analysis of the RCT subgroup indicated that there was no statistically significant difference in IUP rates (RR = 1.04, 95% CI = 0.89–1.21, P = 0.61) nor the repeat ectopic pregnancy (REP) rate (RR = 1.30, 95% CI = 0.72–2.38, P = 0.39) between the salpingotomy and salpingectomy group. In contrast, the cohort study subgroup analysis revealed that the IUP rate was higher in the salpingotomy group compared with the salpingectomy group (RR = 1.24, 95% CI = 1.08–1.42, P = 0.002); Salpingotomy also increased the risk of REP rate (RR = 2.27, 95% CI = 1.12–4.58, P = 0.02). The persistent ectopic pregnancy (PEP) occurred more frequently in the salpingotomy group than the salpingectomy group (RR = 11.61, 95% CI = 3.17–42.46, P = 0.0002). 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 = 1.02–1.32, P = 0.03). The IUP rate (RR = 1.13, 95% CI = 1.01–1.26, P = 0.03), and the REP rate (RR = 1.62, 95% CI = 1.02–2.56, P = 0.04) was higher after salpingotomy than salpingectomy among patients from Europe compared with those from America.ConclusionsBased on the available evidence, we believe that for patients with a healthy contralateral tube operated for tubal pregnancy, the subsequent fertility after salpingectomy and salpingotomy are similar in the long term. The fertility prospects will not be improved via salpingotomy compared with salpingectomy.

National rates, trends and determinants of inpatient surgical management of tubal ectopic pregnancy in the United States, 1998–2011

“…With the exception that patients with prior salpingectomy required higher doses of gonadotropins, cycle characteristics and live birth rates were similar . Currently, there is no data comparing IVF outcomes after either salpingectomy or salpingostomy …”

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Unilateral Atraumatic Expulsion of an Ectopic Pregnancy in a Case of Bilateral Ectopic Pregnancy

“…They found that the two RCTs did not indicate a significant difference between the two groups whereas the cohort studies suggest an increased intrauterine pregnancy (IUP) rate in the salpingostomy group. However, when excluding 2 of the cohort studies, they saw no significant difference between the IUP rates of the two treatment options [13]. …”

Diagnostic and Treatment Modalities for All Localizations of Ectopic Pregnancy

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