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Objective: To evaluate the success rate of laparoscopic neosalpingostomy and the factors affecting the results in terms of intrauterine pregnancy (IUP), delivery (DEL), and ectopic pregnancy (EP)., Design: Retrospective analysis of prospectively recorded data., Setting: Private practice., Patient(s): A total of 434 consecutive infertile patients from 21 to 42 years old with a follow-up of more than 10 years., Intervention(s): Laparoscopic neosalpingostomy., Main Outcome Measure(s): Intrauterine pregnancy, delivery, and EP rates obtained without requiring IVF. Statistical analysis includes univariate and multivariate analysis and crude and actuarial success rates., Result(s): Just over one-quarter (28.8%) of the patients presented an IUP, 24.4% delivered, and 9% presented with an EP. The 5-year actuarial rate of delivery was 37%. This rate was largely dependent on the tubal stage (stage 1: 53.1%; stage 2: 43.1%; stage 3: 24.0%; stage 4: 23.1%). Forty-three percent of the expected IUPs started in the first year, and 75% started in the first two years. Multivariate analysis found some poor-prognosis patterns for tubal stage 3 (odds ratio [OR] 0.24), tubal stage 4 (OR 0.28), repeated neosalpingostomy (OR 0.168), previous EP (OR 0.202), severe adhesion stage (OR 0.211), and positive chlamydial serology (OR 0.515). Eversion with sutures provides nonsignificantly better results (OR 1.63) compared with eversion with coagulation., Conclusion(s): Neosalpingostomy must not be proposed in selected cases according to the tubal stage, adhesion stage, and chlamydial serology. When neosalpingostomy is performed, fimbrial eversion with sutures provides slightly better results., (Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To describe a case of severe intra-abdominal bleeding from omental implants after laparoscopic linear salpingostomy for ectopic pregnancy (EP)., Design: Case report., Setting: A medical center., Patient(s): A 27-year-old woman, presenting 15 days after methotrexate (MTX) treatment for persistent EP (35 days after laparoscopic linear salpingostomy for EP)., Intervention(s): Partial omentectomy., Main Outcome Measure(s): Serial β-hCG levels after partial omentectomy., Result(s): Histopathologic examination confirmed omental pregnancy. Her β-hCG levels decreased rapidly from 1,673 mIU/mL to 1.35 mIU/mL within 14 days after partial omentectomy., Conclusion(s): Persistent EP after laparoscopic linear salpingostomy can occur in the omentum; meticulous clinical follow-up should be performed, especially when IM MTX injection was used as the salvage treatment for persistent EP., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To compare two strategies for managing women after linear salpingostomy for treatment of tubal pregnancy: observation and prophylactic methotrexate., Design: Decision analysis., Setting: Outpatient tertiary-care center., Patient(s): One thousand hypothetical women treated with a linear salpingostomy for ectopic pregnancy., Intervention(s): Observation after salpingostomy and treatment of persistent ectopic pregnancy with a single dose of methotrexate (current standard of care) versus treatment with prophylactic methotrexate at the time of salpingostomy., Main Outcome Measure(s): Number of ruptured ectopic pregnancies, surgical procedures, complications, and cost for each group (observation vs. prophylaxis)., Result(s): Prophylactic methotrexate results in fewer cases of tubal rupture (0.4% vs. 3.7%) and fewer procedures (1.9% vs. 4.7%) at a lower cost ($67.55 less/patient) compared with observation alone. Methotrexate-associated complications occur more frequently with prophylaxis (5.5% vs. 0.8%). Certain conditions change which strategy is preferable. Observation is the best strategy when the persistent ectopic pregnancy rate is <9%, the success of prophylaxis is <95%, the complication rate associated with methotrexate is >18%, or the rupture rate of persistent ectopic pregnancies is <7.3%., Conclusion(s): Prophylactic methotrexate at the time of linear salpingostomy for the treatment of ectopic pregnancy is preferable to observation as long as certain conditions exist.

Objective: To describe a case of persistent trophoblastic tissue after conservative laparoscopic treatment of an ectopic pregnancy (EP)., Design: Case report., Setting: University hospital., Patient: A 19-year-old nulliparous woman, presenting 30 days after conservative laparoscopic treatment of an EP., Intervention(s): Emergency laparotomy, histologic examination of excised trophoblastic tissue, serial beta-hCG levels., Main Outcome Measure(s): Serum beta-hCG clearance curves after surgical treatment of an EP., Result(s): Histology confirmed multiple peritoneal implants of trophoblastic tissue, mainly situated on the sigmoid colon and the omentum majus. Serial beta-hCG levels decreased rapidly from 1,394 to 0 mU/L within 17 days., Conclusion(s): After conservative treatment of EP, patients should be followed up clinically and serial beta-hCG measurements should be obtained to ensure the absence of persistent trophoblastic tissue.

A patient with recurrent ectopic pregnancy is described. The first ectopic gestation was treated by laparoscopic linear laser salpingostomy of the right fallopian tube. Her hCG became negative and a hysterosalpingogram demonstrated right tubal patency. She conceived again after Pergonal ovulation induction, but had a recurrent right ectopic pregnancy. At laparotomy, the pregnancy was extruding through the unhealed incision of her prior linear salpingostomy. This complication of conservative management of ectopic pregnancy has important potential clinical significance.