Laparoscopic Surgical Treatment of Ectopic Pregnancy: Salpingectomy or Salpingostomy?

EDITORIAL COMMENT: We accepted this review for publication because it examines the important point of whether the classical operation of salpingectomy for tubal ectopic pregnancy provides superior results to salpingostomy in terms of subsequent fertility, and the possibility of short‐term complications due to incomplete removal of the ectopic pregnancy, or subsequent complications in terms of recurrence of a further ectopic pregnancy in the same tube. Of course there is seldom an indication for salpingectomy when the ectopic pregnancy is situated in the patient's only remaining Fallopian tube although it can be necessary if the tube is destroyed by rupture or salpingectomy is required to achieve haemostasis. In any case the woman can still become a mother with in vitro fertilization‐embryo transfer technology. This paper contains considerable information about the value of laparoscopy versus laparotomy in the surgical management of ectopic pregnancy but it seems to the Editorial Subcommittee that the important point being examined is whether or not salpingostomy should be attempted rather than salpingectomy in the majority of patients with ectopic tubal pregnancy Summary: There is a widespread belief that salpingostomy is the treatment of choice for ectopic pregnancy. The ability to treat most ectopic pregnancies via a laparoscopic approach has been a major advance in gynaecological surgery. Despite die well publicized benefits of laparoscopy over laparotomy only 50% of patients with ectopic pregnancies in Australia presently benefit from this surgical advance. Although it is clear that laparoscopic treatments are preferable to laparotomy there is no consensus on whether salpingectomy or salpingostomy should be performed, despite over 40 years of research since the introduction of conservative tubal treatment. A systematic review of laparoscopic surgical treatments is needed and could be incorporated into die Cochrane Collaboration. A prospective clinical study, with long‐term follow‐up, needs to be performed to evaluate fertility prognosis and complications after laparoscopic salpingectomy versus salpingostomy.