Laparoscopy versus Conventional Laparotomy for the Management of Tubal Ectopic Pregnancy A Randomized Controlled Trial
Keywords:
Ectopic pregnancy (EP), Laparoscopy, Laparotomy, Beta human chorionic gonadotrophin (?-hCG)Abstract
Objective: To assess the efficacy and surgical morbidity associated with laparoscopic management of tubal ectopic pregnancy (EP) compared to that of open laparotomy.
Study design: A randomized, prospective clinical trial was conducted at a private clinic setting, over a period between February 2007 and December 2012.
Methods: A total of 166 women were admitted for suspected EP. Out of them 149 patients who had confirmed tubal EPs were subjected to different management options (conservative/medical/surgical). The diagnosis was based on the patients history, gynecological examination, ultrasound findings (transvaginal and or transabdominal), and serum [beta human chorionic gonadotrophin (?-hCG)] estimation. Based on inclusion criteria (only haemodynamically stable patients), a total of 85 patients were enrolled for the study. All the enrolled patients were managed surgically and randomly allocated to either laparoscopy group (n = 43) or laparotomy group (n = 42) by lottery method. Data regarding patients demographics, clinical presentation, diagnostic modalities, and treatment outcomes of two surgical techniques (laparoscopy or laparotomy) were recorded for every patient in a pre-designed data capture form. Statistical analysis was done by using SPSS version-15.
Results: No significant differences were found between the two study groups regarding age, parity, gestational age, size & location of the ectopic gestation, the mean pre-operative ?-hCG level, history of previous surgeries, pelvic inflammatory disease, or endometriosis. Total operation time (entry to peritoneal cavity up to exit) needed in the laparoscopic group was less compared to that of laparotomy group (73.2 ± 26.8 min vs. 84.5 ± 34.3 min), which was not statistically significant (p > 0.001). The laparoscopic approach was associated with a reduction in intra-operative blood loss (subjective), need for post-operative analgesia (odds ratio 0.08, 95% CI, 0.040.43) and other post-operative morbidity (odds ratio 0.29, 95% CI, 0.180.55). The length of hospital stay following laparoscopic management was significantly less (p < 0.001) than that of laparotomy group (2.7 ± 0.6 vs. 3.2 ± 1.1 days).
Conclusion: Laparoscopic management of EP offers major benefits in terms of less operating time, fewer analgesics, early recovery, and significantly shorter hospital stay within maximum safety and efficacy.
DOI: http://dx.doi.org/10.11593/bje.2013.0102.0015
Bangladesh Journal of Endosurgery Vol.1(2) May 2013: 35-38
Downloads
207
118
Downloads
Published
How to Cite
Issue
Section
License
Authors of articles published in BJE retain the copyright of their articles and are free to reproduce and disseminate their work. A Copyright and License Agreement signed and dated by the corresponding author on behalf of all authors must be submitted with each manuscript submission.
Copyright Agreement Form
Bangladesh Journal of Endosurgery (BJE) copyright and license agreement:
Title of the Article:
Manuscript No:
In submitting a research article ('article') to Bangladesh Journal of Endosurgery (BJE) I certify that:
1. I am authorized by my co-authors to enter into these arrangements.
2. I warrant, on behalf of myself and my co-authors, that:
- the article is original, has not been formally published in any other peer-reviewed journal, is not under consideration by any other journal and does not infringe any existing copyright or any other third party rights;
- I am/we are the sole author(s) of the article and have full authority to enter into this agreement and in granting rights to BJE are not in breach of any other obligation. If the law requires that the article be published in the public domain, I/we will notify BJE at the time of submission upon which clauses 3 through 6 inclusive do not apply;
- the article contains nothing that is unlawful, libellous, or which would, if published, constitute a breach of contract or of confidence or of commitment given to secrecy;
- I/we have taken due care to ensure the integrity of the article. To my/our - and currently accepted scientific - knowledge all statements contained in it purporting to be facts are true and any formula or instruction contained in the article will not, if followed accurately, cause any injury, illness or damage to the user.
And I agree to the following license agreement:
BJE Open Access license agreement
Brief summary of the agreement
Anyone is free:
- to copy, distribute, and display the work;
- to make derivative works;
- to make commercial use of the work;
Under the following conditions: Attribution
- the original author must be given credit;
- for any reuse or distribution, it must be made clear to others what the license terms of this work are;
- any of these conditions can be waived if the authors gives permission.
Statutory fair use and other rights are in no way affected by the above.
Full BJE Open Access license agreement
(Identical to the 'Creative Commons Attribution License')
Authors Full Name:
Signature:
Date: