Effects of laparoscopic partial salpingectomy followed by end-to-end reanastomosis versus salpingotomy on tubal recanalization and fertility prognosis in women with tubal pregnancy

Abstract:

Objective To investigate the therapeutic effect of laparoscopic partial salpingectomy followed by end-to-end reanastomosis versus salpingotomy on tubal recanalization and fertility prognosis in women with tubal pregnancy.Methods A total of 98 patients with tubal pregnancy with fertility expectation and risk of fertility decline from April 2018 to April 2021 were prospectively included in the study. They were randomly divided into salpingectomy & anastomosis group（n=50） and salpingotomy & suture group（n=48）. The salpingectomy & anastomosis group underwent laparoscopic partial salpingectomy and end-to-end anastomosis. The fallopian tube was retrogradely intubated（the epidural anesthesia catheter was inserted from the umbrella end of the fallopian tube and ran through the two broken ends of the fallopian tube），which was used as a support to assist the anastomosis and hydrotubation during the operation in the salpingectomy & anastomosis group. The salpingotomy & suture group underwent laparoscopic salpingotomy and embryo suture，and 50 mg of methotrexate was routinely injected into the mesangium near the tubal pregnancy sac. The two groups had routine contraception for 3 months after the operation，and salpingography was performed 3 months after operation to observe the patency of fallopian tubes. The operation time，intraoperative bleeding，the incidence of postoperative persistent ectopic pregnancy and the patency of fallopian tubes 3 months after the operation were compared between the two groups. The patients were followed up to observe the occurrence of intrauterine pregnancy and re-tubal pregnancy in the two groups.Results The salpingectomy & anastomosis group had a significantly longer operation time [（52.3±5.7） min vs. （48.6±5.5） min，P=0.002]，less amount of intraoperative bleeding [（6.1±3.9） mL vs.（9.6 ± 5.7） mL，P=0.000]，and lower incidence of postoperative persistent ectopic pregnancy（0.0% vs. 14.6%，P=0.016）than the salpingotomy & suture group，with statistical significance（P<0.05）. Three months after operation，the recanalization rate of fallopian tube was significantly higher in the salpingectomy & anastomosis group（94.0% vs. 79.2%，P=0.030） than the salpingotomy & suture group. All patients were followed up. After（18.5±5.7） months of follow-up，the intrauterine pregnancy rate in the salpingectomy & anastomosis group was significantly higher（58.0% vs. 37.5%，P=0.042），and the incidence of re-tubal pregnancy was significantly lower（2.0% vs. 16.7%，P=0.031） than those in the salpingotomy & suture group respectively. There was no significant difference in the incidence of adverse outcomes of intrauterine pregnancy between the two groups.Conclusion Laparoscopic partial salpingectomy and end-to-end anastomosis is safe and reliable in the treatment of tubal pregnancy，which can reduce the risk of postoperative persistent ectopic pregnancy and re-tubal pregnancy，and improve the postoperative tubal recanalization rate and intrauterine pregnancy rate.