Laparoscopy versus laparotomy in the surgical management of tubal pregnancy : effect of operator experience

Abstract EN

Objective : To examine the surgical treatment of ectopic pregnancy and assess the adherence to the RCOG guidelines regarding the management of tubal pregnancy.

Design : A retrospective study of the surgical management of tubal pregnancy over a 12 months period.

Setting : General hospital in Northern Ireland, UK.

All women operated on for tubal pregnancy in Altnagelvin Area Hospital between 1 / 1 / 2003-31 / 12 / 2003 were included in the study.

Methods : All cases of tubal pregnancy that underwent surgery during 2003 were identified from the computerized theatre log.

The case notes of these women were reviewed and assessed as whether they were managed appropriately by laparotomy or laparoscopic surgery in accordance with the Royal College of Obstetricians and Gynaecologists guidelines 2004 for management of ectopic pregnancy.

Results : 39 cases were identified.

Five (12.8 %) cases underwent appropriate laparotomy.

Of the remaining 34 (87.2 %) cases deemed suitable for laparoscopic management ; 30 out of 34 (88.2 %) cases were managed appropriately by operative laparoscopy.

In total 84.6 % of cases were managed according to the guidelines.

Conclusion and Recommendation : Majority of cases of tubal pregnancy were managed appropriately.

Laparoscopic training at all levels is encouraged to improve the standards.