Fertilité et risque de récidive après traitement chirurgical d’une grossesse extra-utérine : salpingotomie versus salpingectomie

Jamard, A.; Turck, M.; Pham, Alice; Dreyfus, Michel; Benoist, G.

doi:10.1016/j.jgyn.2015.08.005

“…Since prior studies have failed to detect significant differences between laparoscopic salpingostomy and laparoscopic salpingectomy with respect to subsequent fertility, laparoscopic salpingectomy has been preferred over laparoscopic salpingostomy for the treatment of ectopic pregnancy. 10 – 13 …”

Section: Discussionmentioning

confidence: 99%

The effects of conservative and surgical approaches in tubal ectopic pregnancy on fertility

Dur,

Nalcakan,

Aytekin

et al. 2024

Ann Saudi Med

0

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BACKGROUND: Medical treatment, expectant approaches, and surgical treatment options are available in the treatment of ectopic pregnancy. Regardless of the treatment, in addition to its effectiveness, the main concern is to limit the risk of relapse and preserve fertility. OBJECTIVES: Determine the impact of medical or surgical treatment for ectopic pregnancy on future fertility. DESIGN: Retrospective SETTING: Department of obstrtrics and gynecolgy at Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey PATIENTS AND METHODS: Patients who were treated for ectopic pregnancy between June 2016 and November 2019 were allocated into two groups. Expectant approach or medical treatment by methotrexate constituted the conservative treatment group while salpingectomy by laparoscopy indicated the surgical treatment group. MAIN OUTCOME MEASURES: Fertility rates within two years following treatment were evaluated according to treatment options. SAMPLE SIZE: 202 patients RESULTS: Of the 202 patients, 128 had medical treatment and 74 patients had surgical treatment for ectopic pregnancy. Of 272 diagnosed with ectopic pregnancy, 70 were excluded for various reasons. Parity and unemployment rate was significantly higher in the surgical treatment ( P =.006 and P =.12, respectively). Moreover, ectopic mass size and serum β-hCG levels were significantly higher in the surgical treatment group ( P <.001 and P <.001, respectively). There were no significant differences between the conservative and surgical treatment groups in time to pregnancy (17.0 months vs 19.0 months, P =.255). Similarly, there was no significant difference between the conservative and surgical treatment groups with respect to history of infertility ( P =.12). There were no significant differences between the conservative and surgical treatment groups in terms of live birth (51.6% vs 44.6%) and ectopic pregnancy (2.3% vs 1.4%) ( P =.72 for both). There was no significant difference between the conservative and surgical treatment groups with respect to infertility rate (35.9% vs 41.9%, P =.72) and admittance to the IVF program (3.9% vs 6.8%, P =.39) following ectopic pregnancy treatment. CONCLUSIONS: Reproductive outcomes did not differ significantly in women undergoing expectant management, medical treatment, and surgery for ectopic pregnancy. This finding suggests that clinicians should not hesitate to act in favor of surgical treatment for ectopic pregnancy even if there were concerns for future fertility. LIMITATIONS: Retrospective study.

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Fertility outcomes after laparoscopic salpingectomy or salpingotomy for tubal ectopic pregnancy: A retrospective cohort study of 95 patients

Chen

¹

,

Zhu

²

,

Wu

³

et al. 2017

International Journal of Surgery

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A Systematic Review and Meta-analysis of Surgical Treatment of Ectopic Pregnancy with Salpingectomy versus Salpingostomy

Ozcan

¹

,

Wilson

²

,

Frishman

³

2021

Journal of Minimally Invasive Gynecology

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To evaluate the fertility outcomes of salpingectomy compared with those of salpingostomy among patients treated for tubal ectopic pregnancies, including a separate analysis of women with risk factors along with a review of the surgical technique. Data Sources: Systematic review and meta-analysis from 1990 to the present through PubMed, Embase, CINAHL, and Ovid MEDLINE. The search string included "tubal pregnancy" or "ectopic" as well as "salpingectomy" and various terms describing salpingotomy. Methods of Study Selection: Articles studying women who underwent surgical management of an ectopic pregnancy and the contrasted outcomes of salpingectomy vs salpingostomy were reviewed. The primary outcomes included subsequent intrauterine pregnancy (IUP) and repeat ectopic pregnancy (REP). Tabulation, Integration, and Results: Two randomized controlled trials (RCTs), which consisted mostly of patients classified as low risk, and patients from 16 cohort studies were included. In the RCTs, there was no significant difference in the odds of subsequent IUP in patients who underwent a salpingectomy compared with those who were treated with salpingotomy (odds ratio [OR] 0.97; 95% confidence interval [CI], 0.71−1.33). However, a significant and clinically meaningful difference was noted in the cohort studies, with the patients having a lower chance of IUP after salpingectomy (OR 0.45; 95% CI, 0.39−0.52). No significant difference was noted in the OR for a REP in the randomized trials (OR 0.77; 95% CI, 0.41−1.47), but the patients followed in the cohort studies had a cumulatively higher risk of REP after a salpingostomy (OR 0.73; 95% CI, 0.60−0.90). The subgroup analysis examining women within the studies with risk factors for tubal pathology found an even more impressive lowering in the odds of a subsequent IUP in patients classified as at-risk who were treated with salpingectomy (OR 0.30; 95% CI, 0.17−0.54), with a change in the direction of the odds for an REP rate favoring those who were treated with salpingostomy (OR 1.96; 95% CI, 0.88−4.35). Conclusion: Salpingectomy has clear advantages over salpingostomy, and RCTs consisting mainly of patients classified as low risk show no difference in outcomes between salpingectomy and salpingostomy. However, in cohort studies inclusive of all patients, the likelihood of a subsequent spontaneous IUP is decreased in patients treated with salpingectomy, and salpingostomies may be especially underused in women with risk factors for tubal disease.

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Fertilité et risque de récidive après traitement chirurgical d’une grossesse extra-utérine : salpingotomie versus salpingectomie

Cited by 6 publications

References 15 publications

The effects of conservative and surgical approaches in tubal ectopic pregnancy on fertility

The effects of conservative and surgical approaches in tubal ectopic pregnancy on fertility

Fertility outcomes after laparoscopic salpingectomy or salpingotomy for tubal ectopic pregnancy: A retrospective cohort study of 95 patients

A Systematic Review and Meta-analysis of Surgical Treatment of Ectopic Pregnancy with Salpingectomy versus Salpingostomy

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