Salpingectomy - The laparoscopic surgical choice for ectopic pregnancy

The aim of this study was to assess the fertility outcome after ectopic pregnancy (EP) treated by laparoscopic salpingectomy. Among the 375 patients who underwent this operation between January 1983 and December 1993, there were 145 patients who desired pregnancy and whose contralateral tube was not obstructed. The overall rate of intrauterine pregnancy (IUP) was 50.3%, with an EP rate of 15.2%. These results were analysed according to the patients' past history together with the condition of the contralateral tube at the time of the laparoscopy. We defined two groups, Group 1 included patients who had no previous history of tubal surgery and whose contralateral tube was normal. Group 2 comprised those patients who had a previous history of tubal surgery and/or those whose tube was pathological, but not obstructed. Postoperative fertility of the patients in group 1 was significantly higher than that of the patients in group 2, with IUP rates of 75 and 36.6% respectively (P < 0.001), and a risk of EP recurrence of 9.6 and 18.3% respectively. In group 1, the actuarial IUP rate at 24 months was significantly higher than that for the patients in group 2 (66.7 versus 36.9%; P < 0.001). The patient's past history and the condition of the contralateral tube were the two major factors related to fertility outcome after laparoscopic salpingectomy for EP. In patients with no past history of tubal surgery or infertility and whose contralateral tube was normal, the fertility results after laparoscopic salpingectomy appeared comparable to those observed after conservative laparoscopic treatment.