Laparoscopic salpingostomy versus laparoscopic local methotrexate injection in the management of unruptured ectopic gestation.

Abstract

Our goal was to determine whether laparoscopic salpingostomy is preferable to laparoscopic methotrexate injection in the management of unruptured tubal gestation. Forty-eight patients with unruptured tubal pregnancy were prospectively randomized to either laparoscopic salpingostomy or laparoscopic local methotrexate injection in a university medical center. Operation time, duration of hospital stay, decrease in levels of beta-human chorionic gonadotropin, and fertility outcome were compared between the two groups. The salpingostomy group had a longer operative time (p < 0.0001) but a shorter hospital stay (p < 0.01) and a lower incidence of persistent trophoblastic activity (5% vs 14%), although this difference did not reach statistical significance. The time interval until beta-human chorionic gonadotropin disappearance was similar (13.9 and 13.7 days), and the subsequent intrauterine pregnancy rate was similar in the two groups (83.5% and 81%). One repeat tubal pregnancy occurred in the salpingostomy group. Both these methods of conservative management are equally effective and each one has its merits.