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To assess whether post-hysterosalpingography evaluation was associated with pregnancy rate and to identify independent risk factors for pregnancy success after salpingostomy in patients with hydrosalpinx. A retrospective analysis was conducted on the clinical data of 47 patients diagnosed with hydrosalpingography (HSG) in our hospital from 2015 to 2018. These patients received laparoscopic surgery and another salpingography within 2 months after surgery. According to the fallopian tube conditions evaluated by HSG before and after surgery, the patients could be divided into two groups. According to the pregnancy rate and postoperative HSG of patients with hydrosalpinx after laparoscopy, the total pregnancy rate of the tubal improved group was 65.62%, while that of the non-improved group was 20%, with statistical significance ( p  < 0.05). We found that hysterosalpingography after salpingostomy in patients with hydrosalpinx can provide reference for clinical treatment and improve the prognosis of patients.

Background: The management of ectopic pregnancy is widely debated. Salpingectomy, salpingostomy, and expectant management are widely performed, but the best approach in terms of keeping good future spontaneous fertility chances is yet to be determined. Material and methods: We performed a retrospective analysis (Clinical Trial ID: NCT05479786) of the medical records of patients with an ultrasonographic or surgical diagnosis of tubal ectopic pregnancy that were admitted to the University of Debrecen Clinical Centre between 2012 and 2020. Results: A total of 312 patients were included in the analysis. Patients managed expectantly and patients treated with salpingostomy had significantly higher rates of clinical pregnancy than patients treated with salpingectomy. Pregnancy outcomes and recurrence rates were comparable between the study groups. Salpingectomy was found to decrease the likelihood of conceiving spontaneously by 65%. A stratified analysis based on serum β-HCG levels demonstrated that all treatment modalities carry the same reproductive opportunities for patients presenting with β-HCG levels ≤ 1745 IU/L. Conclusion: Salpingectomy was found to decrease the patient's chance of achieving a natural conception. Conservative approaches should be considered with caution only when the patient's clinical condition permits, and the patient is appropriately counseled.

Background: Bilateral ectopic pregnancy is extremely rare, with a tremendous maternal mortality and morbidity risk, requiring rapid diagnosis and management. This condition is usually diagnosed during surgery, as radiologists may not pay enough attention to the contralateral side of interest. Therefore, reminding of this rare but emergent situation can be beneficial for both radiologists and gynecologists. Here we report a case of bilateral ectopic pregnancy, which was first diagnosed with ultrasound and was confirmed during laparoscopy., Case Presentation: A 34 years old woman complaining of light vaginal bleeding at 6 weeks of gestation by her last menstrual period presented to our institute. The serum β-HCG levels were analyzed and followed during patient's admission. Unfortunately, serum levels weren't decreasing and blood test titration before surgery were as: 851,894,975 IU/l (checked daily and not every 48 h because of patient's status and being bilateral). There was no evidence of intrauterine pregnancy at the transvaginal ultrasound, but heterogeneous adnexal masses were seen at both adnexa, suspected of bilateral ectopic pregnancy. She underwent laparoscopic exploration, which confirmed the diagnosis. Bilateral salpingostomy was done to preserve fertility, and the patient's recovery was uneventful., Conclusions: Even with a unilateral report of ectopic pregnancy preoperatively in ultrasonography, surgeons should always be aware of the probability of bilateral ectopic pregnancies anytime facing susceptible cases, especially in patients with known risk factors. Also, it is an important reminder for radiologists to check both adnexa when facing a unilateral adnexal mass resembling ectopic pregnancy., (© 2023. The Author(s).)

Objectives: The aim of this study was to investigate the impact of a history of recurrent ectopic pregnancy (EP) on pregnancy outcomes of subsequent in vitro fertilization (IVF) treatment., Methods: A retrospective cohort study involving 457 women with a history of recurrent EP (REP group), 912 women with a history of single EP (SEP group), and 1169 women with a history of intrauterine pregnancy (IUP group) as the control group, was conducted. IVF outcomes were compared for each cohort., Results: The incidence of EP in the REP group after IVF treatment was significantly lower than those in the SEP group (2.4% vs. 6.8%, P = 0.011), and similar to those in the IUP group (2.4% vs. 2.1%, P = 0.830). No significant differences were observed in the clinical pregnancy rate, miscarriage rate, and live birth rate among the three groups. There was no statistically significant difference in the recurrent EP rate between the salpingectomy and salpingostomy treatments. Adjusting for maternal and treatment factors did not influence live birth rates for women with previous REP compared with women with previous SEP and those with IUP. The odds of EP were 82.2% lower (OR 0.178, 95% CI 0.042-0.762; P = 0.020) in women who had blastocyst transfer compared with cleavage embryo transfer in the SEP group. The odds of EP were over six times (OR 6.260, 95% CI 1.255-31.220; P = 0.025) in women who underwent double embryo transfer as opposed to single embryo transfer in the IUP group., Conclusion: Our results indicate that women with previous recurrent EP have a lower risk of EP after IVF in comparison with women with previous single EP. Previous EP has no significant adverse effect on the main IVF outcomes. The salpingostomy and salpingectomy treatments of EP do not significantly affect the incidence of recurrent EP after IVF., Competing Interests: The authors have declared that no competing interests exist.

Objective: To evaluate the effectiveness of laparoscopic tubal anastomosis for tubal occlusions associated with infertility in patients with previous laparoscopic salpingostomy for ectopic pregnancy., Methods: This study is a retrospective analysis of the pregnancy outcomes of 173 infertile patients who underwent hysteroscopy and laparoscopic tubal anastomosis treatment between January 2013 and August 2018 in the Department of Reproductive Endocrinology in West China Second University Hospital of Sichuan University. All patients had a history of laparoscopic salpingostomy for tubal pregnancy. The primary outcomes were intrauterine pregnancy, ectopic pregnancy, and delivery rates. We further studied the associated factors that could influence the change in pregnancy status., Results: The 24-month cumulative clinical pregnancy rate of all patients was 107/173 (61.8%). The distribution of outcomes for the entire group of pregnancies was as follows: intrauterine pregnancy rate, 76/173 (43.9%); ectopic pregnancy rate, 31/173 (17.9%); delivery rate, 68/173 (39.3%); and miscarriage rate, 8/173 (4.6%). Age, type of anastomosis, hydrosalpinx, and endometrial polyps were significant prognostic factors in the multivariate model., Conclusion: Laparoscopic tubal anastomosis is an effective treatment for tubal-associated infertility due to previous laparoscopic salpingostomy for ectopic pregnancy, especially for women under 35 years of age., (© 2021 International Federation of Gynecology and Obstetrics.)

Objective: To conduct a systematic review and meta-analysis evaluating the effect of hydrosalpinx on pregnancy outcomes, to compare different types of management of hydrosalpinx and their impact on pregnancy rates as well as on the ovarian reserve., Data Sources: Electronic search using Pubmed, EMBASE, Ovid MEDLINE, Google Scholar, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials and including all published studies that examined tubal infertility and its management (assisted reproductive technology or surgery) as well as the effects on ovarian reserve. The following medical subject headings (Mesh) terms combinations were used: "fallopian tube disease," hydrosalpinx," "tubal or salpinx occlusion or obstruction," "in vitro fertilization," "fallopian tube surgery," "salpingectomy," "salpingostomy," "infertility," "subfertility," "sterility" and "ovarian reserve.", Methods of Study Selection: All randomized trials, cohort, and case controls studies were included. We excluded review articles, meeting abstracts, case series and case reports, and abstracts without access to full texts. The search was limited to trials in humans and published in English., Tabulation, Integration, and Results: Our electronic search initially retrieved 6354 articles. Finally, 19 studies were included in the quantitative evaluation of the effects of hydrosalpinx: 23 in the qualitative evaluation and 5 in the quantitative evaluation of different types of hydrosalpinx treatments; and 17 in the quantitative evaluation of ovarian reserve. The presence of a hydrosalpinx was associated with decreased rates of implantation and clinical pregnancy, and increased rates of ectopic pregnancy and miscarriage. Management of hydrosalpinx with salpingectomy, tubal occlusion, or hydrosalpinx aspiration led to better in vitro fertilization pregnancy rates. We found no difference in ovarian response to stimulation after salpingectomy except a decrease in antimüllerian hormone compared to no surgery., Conclusions: The presence of hydrosalpinx is associated with decreased pregnancy rate and increased rates of ectopic pregnancy and miscarriage. Management of hydrosalpinx, regardless of the type of treatment, leads to an increased chance of pregnancy., (Copyright © 2020 AAGL. Published by Elsevier Inc. All rights reserved.)

Endoscopic surgery of ectopic pregnancy is actually the gold standard for the management of fallopian tubal diseases. A survey was conducted to evaluate fertility in patients who underwent endoscopic management for ectopic pregnancy. A retrospective study was conducted at the department of general and endoscopic surgery of the Point "G" teaching hospital, in Bamako, Mali, from January 1st 2007 to December 31, 2016. Forty-eight (48) patients who underwent endoscopic management of tubal ectopic pregnancy and who have been followed up for fertility were included in this study. Statistical tests used were X2 or Fisher test and their confident interval, p <1 % has been considered as statistically significant. The therapeutic score of Pouly was less than 4 in 25.0% (n = 12). The return to fertility was observed among 48.0% of patients (n = 23). The chance of conception was less than 80.0% after the fourth postoperative year (p=0.001). The outcome of pregnancies has been seventeen full-term pregnancies, three ectopic pregnancies and three miscarriages. The occurrence of pregnancy after endoscopic management indicated for ectopic pregnancy is possible. However, many factors can influence the future conception.

Background: This study aims to investigate the influencing factors of pregnancy after laparoscopic oviduct anastomosis., Methods: The data of 156 cases of laparoscopic oviduct anastomosis in our hospital were analyzed., Results: The pregnancy rate decreased with age (P < 0.005). The pregnancy rate after six years of anastomosis was higher in those with ligation (P < 0.005). The postoperative pregnancy rate significantly increased in subjects with oviduct lengths of > 7 cm (P < 0.01). The pregnancy rate of isthmus end-to-end anastomosis was higher (P < 0.005). The pregnancy rate after bilateral tubal recanalization was higher than that after unilateral tubal recanalization (P < 0.005). The pregnancy rate after laparoscopic tubal ligation and laparoscopic anastomosis was higher than that of open tubal ligation and laparoscopic anastomosis (P < 0.005)., Conclusion: The pregnancy rate after laparoscopic oviduct anastomosis is higher in subjects below 35 years old, with a ligation duration of < 6 years, and a length of oviduct of > 7 cm, and those who underwent isthmus anastomosis and laparoscopic oviduct ligation and recanalization.

Study Objective: To identify factors predictive of persistent ectopic pregnancy (PEP) in women who have undergone laparoscopic salpingostomy or salpingotomy for tubal pregnancy., Design: Retrospective cohort study (Canadian Task Force classification II-2)., Setting: Tertiary referral center., Patients: Ninety-nine women who underwent laparoscopic tubal preservation surgery for ectopic pregnancy., Interventions: Seventy women underwent laparoscopic salpingostomy, and the remaining 29 women underwent laparoscopic salpingotomy., Measurements and Main Results: Factors predicting PEP were evaluated. The change in serum beta human chorionic gonadotropin (β-hCG) levels from baseline observed between postoperative days 5 and 10 (ChCGD5-10) was a predictor of PEP (odds ratio [OR], 0.80; p = .01). Based on receiver operating characteristic (ROC) curve analysis, a cutoff value of 93.1% was determined, with an area under the ROC curve of 0.95 (sensitivity, 85.7%; specificity, 100%). Nonetheless, when considering perioperative variables only, body mass index (BMI) was identified as a predictor of PEP (OR, 0.71; p = .03). Based on the ROC analysis, a BMI cutoff value of ≤22 kg/m 2 was determined, with an ROC area of 0.73 (sensitivity, 43.2%; specificity, 100%). In addition, a higher baseline β-hCG level (hazard ratio [HR], 1.0002; p = .009) and left tubal pregnancy (HR, 6.46; p = .03) were predictive of recurrent ectopic pregnancy. There were no differences in the perioperative outcomes, PEP rates, or subsequent intrauterine pregnancy rates between the salpingostomy and salpingotomy groups. In addition, surgical method was not a predictor of recurrent ectopic pregnancy., Conclusions: ChCGD5-10 was identified as a predictor for PEP, suggesting that it might be more clinically useful for the follow-up of PEP. When considering perioperative variables only, BMI was a predictor for PEP. In addition, there was no significant difference in clinical outcomes between the salpingostomy and salpingotomy groups., (Copyright © 2018 AAGL. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to improve clinical decision-making for the identification of persistent ectopic pregnancy after linear salpingostomy. The study identified 854 laparoscopic salpingostomies performed between 2011 and 2016; 794 had a human chorionic gonadotrophin (HCG) <10 mIU/ml documented in the electronic medical record within 1 month after surgery ('successes'). Sixty (7%) received either methotrexate or repeat surgery for persistent ectopic pregnancy ('failures'). Five hundred and seventeen, including 46 'failures', had two or more immediate post-operative HCG measurements available. The most clinically useful prediction rule was calculated by dividing the difference between the first and second post-operative HCG values by the first post-operative HCG value (i.e. [HCG1 - HCG2]/HCG1). When this ratio exceeded 0.75, it reliably ruled out persistent ectopic with a negative predictive value = 99%. When this ratio was less than 0.2, it identified persistent ectopics with a positive predictive value = 88%. It appears that this simple arithmetic calculation involving two early post-operative HCG values may allow for efficient triage of patients before post-operative day 5. If validated in prospective studies, this could help minimize the risk, inconvenience and expense of requiring several weeks of frequent follow up to rule in/rule out persistent ectopic pregnancy., (Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Study Objective: To determine whether different treatment approaches of ectopic pregnancy (EP), particularly unilateral salpingectomy and methotrexate, affect its recurrence rate in patients undergoing in vitro fertilization (IVF)., Design: A retrospective cohort study (Canadian Task Force classification II-2)., Setting: An academic medical center., Patients: Patients with a history of a previous EP who achieved pregnancy after IVF cycles between January 2004 and August 2015 were included. The recurrence rate of EP was compared between patients who underwent different treatment approaches for a previous EP., Interventions: IVF., Measurements and Main Results: A total of 594 patients were included. Seventeen patients had a recurrence of EP (2.9%). Patients with a history of ≥2 EPs were associated with a significantly higher recurrence rate of EP than those with 1 previous EP (8.5% vs. 1.8%; p = .01; odds ratio [OR] = 2.2; 95% confidence interval [CI], 1.2-4.4). Patients who underwent unilateral salpingectomy (n = 245) had a comparable recurrence rate of EP after IVF with those who received methotrexate (n = 283) (3.6% vs. 2.8%; p = .5; OR = 1.3; 95% CI, 0.4-3.4). This OR remained unchanged after adjusting for patient's age, number of previous EPs, number of transferred embryos, and peak estradiol level during stimulation (adjusted OR = 1.4; 95% CI, 0.5-3.8). None of the patients who underwent bilateral salpingectomy (n = 45) or salpingostomy (n = 21) had a recurrence of EP after IVF., Conclusion: The recurrence rate of EP significantly correlates with the number of previous EPs. Treatment of EP with methotrexate has a comparable recurrence rate of EP after IVF with unilateral salpingectomy. Therefore, the risk of recurrence should not be a reason to favor salpingectomy over methotrexate in this population., (Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.)

Background: Ectopic pregnancy is common among young women. Treatment can consist of either surgery with salpingectomy or salpingostomy or medical management with methotrexate. In addition to acute complications, treatment of ectopic pregnancy can result in long-term sequelae that include decreased fertility. Little is known about the patterns of care and predictors of treatment in women with ectopic pregnancy. Similarly, data on outcomes for various treatments are limited., Objective: We examined the patterns of care and outcomes for women with ectopic pregnancy. Specifically, we examined predictors of medical (vs surgical) management of ectopic pregnancy and tubal conservation (salpingostomy vs salpingectomy) among women who underwent surgery., Study Design: The Perspective database was used to identify women with a diagnosis of tubal ectopic pregnancy treated from 2006-2015. Perspective is an all-payer database that collects data on patients at hospitals from throughout the United States. Women were classified as having undergone medical treatment, if they received methotrexate, and surgical treatment, if treatment consisted of salpingostomy or salpingectomy. Multivariable models were developed to examine predictors of medical treatment and of tubal conserving salpingostomy among women who were treated surgically., Results: Among the 62,588 women, 49,090 women (78.4%) were treated surgically, and 13,498 women (21.6%) received methotrexate. Use of methotrexate increased from 14.5% in 2006 to 27.3% by 2015 (P<.001). Among women who underwent surgery, salpingostomy decreased over time from 13.0% in 2006 to 6.0% in 2015 (P<.001). Treatment in more recent years, at a teaching hospital and at higher volume centers, were associated with the increased use of methotrexate (P<.05 for all). In contrast, Medicaid recipients (adjusted risk ratio, 0.92; 95% confidence interval, 0.87-0.98) and uninsured women (adjusted risk ratio, 0.87; 95% confidence interval, 0.82-0.93) were less likely to receive methotrexate than commercially insured patients. Among those who underwent surgery, black (adjusted risk ratio, 0.76; 95% confidence interval, 0.69-0.85) and Hispanic (adjusted risk ratio, 0.80; 95% confidence interval, 0.66-0.96) patients were less likely to undergo tubal conserving surgery than white women and Medicaid recipients (adjusted risk ratio, 0.69; 95% confidence interval, 0.64-0.75); uninsured women (adjusted risk ratio, 0.60; 95% confidence interval, 0.55-0.66) less frequently underwent salpingostomy than commercially insured patients., Conclusion: There is substantial variation in the management of ectopic pregnancy. There are significant race- and insurance-related disparities associated with treatment., (Copyright © 2017 Elsevier Inc. All rights reserved.)

A leading cause of maternal mortality in the first trimester is hemorrhage due to a ruptured ectopic pregnancy. With the advent of tube salvage surgery, ectopic pregnancies can be removed while ensuring hemostasis and preserving the integrity of the fallopian tube. A major drawback of tube salvage surgery is the significant risk of persistent trophoblastic tissue being left behind. We report a case of a 30year old female who presented to the ED with acute abdomen and hemoperitoneum due to a ruptured ectopic pregnancy. She was treated with salpingostomy and the pathologic report confirmed removal of the ectopic pregnancy. After an initially uneventful post-operative recovery, she presented to the ED 27days later with signs of acute abdomen and hemoperitoneum. Surgical intervention confirmed a ruptured ectopic pregnancy in the same site as previous, and salpingectomy was performed, after which the patient recovered without complications. The increased risk of persistent trophoblastic tissue associated with tube salvage surgery can lead to subsequent reoperation for tubal rupture. Patients undergoing these procedures should be closely monitored in the following weeks and undergo serial β-hCG testing in order to confirm successful removal of the ectopic., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To study the risk factors for recurrent ectopic pregnancy (REP)., Design: A retrospective case-control study., Setting: A university medical centre., Population: 554 women with a history of ectopic pregnancy (EP) were included. Among them were 181 women with current EP, 184 women with current intrauterine pregnancy (IUP) and 189 nonpregnant women (NonP)., Methods: The three groups were matched at a ratio of 1:1 with respect to current age, age of initial EP and gestational week of initial EP. Socio-demographic characteristics, reproductive history, gynaecological and surgical history, and experience of contraception were compared among the three groups. A multivariable logistic regression analysis was used to adjust for confounders and calculate adjusted odds ratios (AORs)., Results: The risk of REP increased with history of infertility (AOR = 3.84, 95%CI 2.16-6.86) in REP women compared with IUP controls. Compared with NonP controls, salpingotomy (AOR = 3.04, 95%CI 1.21-36.51) for previous EP was a risk factor for REP. Multiparous women were less likely to suffer REP when compared with NonP women (AOR = 0.36, 95%CI 0.18-0.62) or IUP controls (AOR = 0.35, 95%CI 0.20-0.62). Current use of an intrauterine device (IUD) (REP versus NonP, AOR = 0.02, 95%CI 0.00-0.08) or condoms (REP versus NonP, AOR = 0.16, 95%CI 0.07-0.38) significantly reduced the risk of REP compared with those not using any contraception. Similarly, previous use of condoms also prevented REP compared with those with no previous condom use (REP versus NonP, AOR = 0.20, 95%CI 0.08-0.49; REP versus IUP, AOR = 0.40, 95%CI 0.22-0.71)., Conclusions: Women with history of infertility or salpingotomy should be alert for the recurrence of EP. Multiparous women are less likely to suffer REP. We propose the use of condoms for effective prevention of REP., Tweetable Abstract: History of infertility and salpingotomy for last EP are risk factors for recurrent EP., (© 2016 Royal College of Obstetricians and Gynaecologists.)

Objective: To assess the objectivity and accuracy of a new system that predicts the pregnancy outcomes in patients with tubal pregnancy after laparoscopic salpingostomy., Study Design: 480 tubal pregnancy patients were retrospectively stratified as mild, moderate, or severe group according to the new tubal classification system in which pelvic adhesions, tubal morphology, structure, and patency were included. The follow-up was performed for 24 months to determine spontaneous pregnancy outcomes., Results: The tubal classification was significantly associated with intrauterine pregnancy rates (mild 70.9% vs. moderate 66.0% vs. severe 41.8%, P=0.001) and recurrent ectopic pregnancy rates (mild 2.8% vs. moderate 4.2% vs. severe 10.9%, P=0.047). The 24-month cumulative rate of intrauterine pregnancy was 73.5% in the mild group, 68.5% in the moderate group, and 45.8% in the severe group (P=0.002). The 24-month cumulative repeat ectopic pregnancy rate was 6.6% in the mild group, 9.1% in the moderate group, and 15% in the severe group (P=0.154). In Cox multivariate regression analysis, a lack of a history of infertility [hazard ratio (HR)=0.633, P=0.001] and tubal scoring (mild HR=2.408, P=0.008; moderate HR=2.147, P=0.010) were significantly associated with a higher rate of spontaneous intrauterine pregnancy. Having a history of infertility (HR=0.351, P=0.037) and no prior abdominopelvic surgery (HR=2.907, P=0.014) were significantly associated with a lower ectopic pregnancy rate., Conclusion: The new tubal classification system significantly correlated with spontaneous pregnancy outcomes in patients with tubal pregnancy following laparoscopic salpingostomy., (Copyright © 2016. Published by Elsevier Ireland Ltd.)

Objective: This study aimed to assess the effects of hysterectomy and bilateral salpingo-oophorectomy (BSO)--compared with the effects of hysterectomy alone--on skin aging in premenopausal women undergoing hysterectomy for benign conditions., Methods: One hundred thirty-five premenopausal women who underwent hysterectomy with BSO were compared with a control group of women who underwent hysterectomy alone based on skin parameters (including wrinkling, laxity/sagging, and texture/dryness) and Skindex-29 questionnaire scores. The inclusion criteria were as follows: aged between 40 and 50 years, follicle-stimulating hormone level lower than 40 mIU/mL, undergoing hysterectomy with or without BSO for benign conditions, and not receiving estrogen or progesterone treatment. The exclusion criteria were as follows: adrenocortical hyperplasia or Cushing's syndrome; use of corticosteroids for autoimmune diseases; malignancy, connective tissue diseases (eg, Ehlers-Danlos syndrome), or dermatological diseases (eg, lichen sclerosus); or regular use of medications known to interfere with the condition of the skin., Results: All skin parameters in the hysterectomy group and the hysterectomy with BSO group worsened on weeks 24 and 48. Laxity/sagging and texture/dryness scores on weeks 24 and 48 were significantly worse in the BSO group; laxity/sagging and texture/dryness scores continued to worsen between 24 and 48 weeks. Scores for the Skindex-29 questionnaire emotion and symptom subscales were significantly higher in the BSO group compared with the non-BSO group., Conclusions: Prophylactic BSO during hysterectomy is a significant independent risk factor for worsening skin laxity/sagging and texture/dryness in premenopausal women undergoing hysterectomy for benign conditions. Prophylactic BSO in the presence of dermatological conditions is also associated with reduced quality of life.

Unlabelled: Two surgical techniques can be performed for the treatment of an ectopic pregnancy (EP): a conservative one called salpingostomy and a radical one called salpingectomy. We compared both techniques to find differences about fertility or risk of recurrence., Material and Methods: We retrospectively reviewed all the women who underwent a surgical treatment for an ectopic pregnancy in the university's hospital of Caen between 2008 and 2011. We compared the results of both techniques. The primary end-point was the rate of intra-uterine pregnancy and the second end-point was the rate of recurrence of the EP. We also try to identify other risk factor of infertility., Results: One hundred and fifty-two patients have been listed initially. Ninety-eight patients still attempt to become pregnant after the EP. In the conservative group, the rate of intra-uterine pregnancy was 88% (n=22) and the rate of recurrence was 8% (n=2). In the radical group, the rate of intra-uterine pregnancy was 68% (n=50) and the rate of recurrence was 5% (n=3). We could not identify any significant difference in the subsequent fertility or in the recurrence's risk between conservative and radical surgery. The age of the patient has been identified as a significative risk factor of infertility., Conclusion: To choose the surgical technique of an EP, the wish of pregnancy, the risk factor of infertility of the patient and the laparoscopic observations have to be taken into account. It seems that there is no difference between the two surgical techniques., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Aim: To compare the subsequent reproductive outcome after laparoscopic salpingostomy or salpingectomy for tubal ectopic pregnancy (EP)., Material of Study: A retrospective cohort study was conducted between January 2002 and May 2014 on 132 women admitted to Unit of Gynecology and Obstetrics of the Department of Human Pathology in Adulthood and Childhood "G. Barresi", "Gaetano Martino" Hospital, University of Messina (Italy), with EP and who received surgical treatment, including laparoscopic salpingectomy (n=57) or salpingostomy (n=75). Main outcomes included intrauterine pregnancy (IUP), recurrent EP and persistent trophoblastic disease rates., Results: The IUP rates up to 24 months after surgery were 56.1% for salpingectomy and 60% for salpingostomy. The 2-year recurrent EP rates were 5.3% for salpingectomy and 18.7% for salpingostomy. The persistent trophoblastic disease rate were 1.8% for salpingectomy and 12% for salpingostomy., Discussion: Our results show that the reproductive outcomes after laparoscopic salpingectomy are similar to those observed after conservative treatment., Conclusions: In the surgical treatment of EP, the clinician should choose the best treatment in accordance with the patient, considering the severity of the disease, the clinical characteristics of the patient and her desire to preserve fertility., Key Words: Ectopic pregnancy, Salpingectomy,Salpingostomy.

Study Question: Is salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube?, Summary Answer: Salpingotomy is not cost effective over salpingectomy as a surgical procedure for tubal pregnancy, as its costs are higher without a better ongoing pregnancy rate while risks of persistent trophoblast are higher., What Is Known Already: Women with a tubal pregnancy treated by salpingotomy or salpingectomy in the presence of a healthy contralateral tube have comparable ongoing pregnancy rates by natural conception. Salpingotomy bears the risk of persistent trophoblast necessitating additional medical or surgical treatment. Repeat ectopic pregnancy occurs slightly more often after salpingotomy compared with salpingectomy. Both consequences imply potentially higher costs after salpingotomy., Study Design, Size, Duration: We performed an economic evaluation of salpingotomy compared with salpingectomy in an international multicentre randomized controlled trial in women with a tubal pregnancy and a healthy contralateral tube. Between 24 September 2004 and 29 November 2011, women were allocated to salpingotomy (n = 215) or salpingectomy (n = 231). Fertility follow-up was done up to 36 months post-operatively., Participants/materials, Settings, Methods: We performed a cost-effectiveness analysis from a hospital perspective. We compared the direct medical costs of salpingotomy and salpingectomy until an ongoing pregnancy occurred by natural conception within a time horizon of 36 months. Direct medical costs included the surgical treatment of the initial tubal pregnancy, readmissions including reinterventions, treatment for persistent trophoblast and interventions for repeat ectopic pregnancy. The analysis was performed according to the intention-to-treat principle., Main Results and the Role of Chance: Mean direct medical costs per woman in the salpingotomy group and in the salpingectomy group were €3319 versus €2958, respectively, with a mean difference of €361 (95% confidence interval €217 to €515). Salpingotomy resulted in a marginally higher ongoing pregnancy rate by natural conception compared with salpingectomy leading to an incremental cost-effectiveness ratio €40 982 (95% confidence interval -€130 319 to €145 491) per ongoing pregnancy. Since salpingotomy resulted in more additional treatments for persistent trophoblast and interventions for repeat ectopic pregnancy, the incremental cost-effectiveness ratio was not informative., Limitations, Reasons for Caution: Costs of any subsequent IVF cycles were not included in this analysis. The analysis was limited to the perspective of the hospital., Wider Implications of the Findings: However, a small treatment benefit of salpingotomy might be enough to cover the costs of subsequent IVF. This uncertainty should be incorporated in shared decision-making. Whether salpingotomy should be offered depends on society's willingness to pay for an additional child., Study Funding/competing Interests: Netherlands Organisation for Health Research and Development, Region Västra Götaland Health & Medical Care Committee., Trial Registration Number: ISRCTN37002267., (© The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

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: BRCA1/2 mutation carriers have greatly elevated lifetime risks of breast, ovarian, and fallopian tube cancers. Bilateral prophylactic salpingo-oophorectomy is recommended to prevent cancer in these women. As it is often performed before natural menopause, it may be accompanied by menopausal symptoms, impaired quality of life, and increased cardiovascular risk., Methods: In this review, we describe the indications, timing, and implications of salpingo-oophorectomy for BRCA-positive women, with a special focus on the risks and benefits of hormone therapy (HT). Furthermore, retrospective and prospective trials of HT in BRCA mutation carriers undergoing prophylactic salpingo-oophorectomy are debated., Results: Hormonal deprivation after prophylactic salpingo-oophorectomy may negatively impact health and quality of life; most women experience menopausal symptoms shortly after surgical operation. Literature data suggest that HT generally reduces vasomotor symptoms related to surgical menopause, improving sexual functioning without affecting survival., Conclusions: Despite the limitations of retrospective and prospective observational studies, short-term HT seems to improve quality of life and does not seem to have an adverse effect on oncologic outcomes in BRCA1 and BRCA2 mutation carriers without a personal history of breast cancer. Therefore, randomized and larger trials are urgently needed.

Study Objective: To evaluate the safety and feasibility of single-port laparoscopic adnexal surgery during pregnancy., Design: A retrospective study (Canadian Task Force Classification III)., Setting: A university hospital., Patients: A total of 14 women with intrauterine pregnancy who underwent single-port laparoscopic surgery (SPLS)., Intervention: We retrospectively reviewed the medical records of 14 women with intrauterine pregnancy who underwent SPLS between November 2009 and September 2012 for the treatment of an adnexal mass., Measurements and Main Results: Factors investigated included the duration of surgery, differences between preoperative and postoperative hemoglobin, the size of the mass as measured by ultrasonography, major intraoperative or postoperative complications, conversion to multiport laparoscopy, and pregnancy outcomes. Single-port laparoscopic adnexal surgery was successfully performed in all 14 pregnant patients with an adnexal mass. The median gestational age at operation was 9 weeks (range, 4 weeks-17 weeks 4 days). Procedures included ovarian cystectomy with or without detorsion (n = 9), cyst aspiration with detorsion (n = 2), salpingectomy (n = 2), and salpingostomy (n = 1). The median duration of surgery was 59 minutes (range, 36-84 minutes). No major intraoperative or postoperative complications were encountered, and there was no need for conversion to multiport laparoscopic surgery. Five women had spontaneous vaginal delivery, and 5 women underwent cesarean delivery at term. One woman had preterm delivery at a gestational age of 24 weeks 5 days. In 1 case, abortion occurred 2 weeks after the operation., Conclusion: Based on these initial findings, SPLS appears to be a safe and technically feasible treatment for an adnexal mass during pregnancy., (Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.)

This study is aimed to evaluate the impact of laparoscopic salpingostomy on ovarian stromal blood flow indices in patients with ectopic pregnancy, and to compare the ovarian stromal blood flow indices with matched paired healthy women. We included 37 patients who underwent laparoscopic salpingostomy and 37 age- and parity-matched women as controls. The main outcome was the differences in ovarian volume, antral follicle count (AFC), and ovarian stromal blood flow indices between the study group participants after the surgery and the healthy controls. Comparison of the ovarian parameters between the study group after the surgery and the control group revealed no significant differences in terms of ovarian volume (p = 0.783), AFC (p = 0.253), ovarian stromal S/D ratios (p = 0.054), pulsatility index (PI; p = 0.938) and resistance index (RI; p = 0.041). In addition, comparison of the ovarian parameters before and after the surgical treatment revealed no significant differences in the ovarian volume (p = 0.141), AFC (p = 0.084), ovarian stromal S/D ratios (p = 0.187), PI (p = 0.102) and RI (p = 0.108). In conclusion, laparoscopic salpingostomy does not affect ovarian function in terms of ovarian stromal blood flow indices, ovarian volume, and AFC.

Objective: To evaluate whether laparoscopic salpingectomy compromises ovarian response in women undergoing controlled ovarian hyperstimulation in vitro fertilization (IVF)., Methods: In a retrospective study in Changsha, China, data from 76 women who underwent ovarian stimulation before and after laparoscopic salpingectomy for ectopic pregnancy were compared with those from 80 women who underwent 2 IVF cycles without surgical intervention between 2004 and 2009., Results: There were no differences in basal serum follicle-stimulating hormone (FSH) or estradiol (E(2)); length of stimulation; or numbers of follicles, retrieved and fertilized oocytes, or high-quality embryos between the cycles before and after salpingectomy; however, initial and total doses of gonadotropins were significantly increased after surgery (P<0.05). IVF parameters were also comparable between the 2 cycles among women without surgical intervention, except for a significant increase in initial and total doses of gonadotropins at the second cycle (P<0.05). IVF parameters did not differ between the cycle subsequent to salpingectomy and the second cycle in women without surgical intervention. There were no significant differences between patients with unilateral and those with bilateral salpingectomy, nor between the operated and non-operated ovary in the same individual., Conclusion: Laparoscopic salpingectomy had no detrimental effect on ovarian response during IVF-embryo transfer treatment., (Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Study Objective: The assessment of future fertility in patients that were hospitalized with diagnosis of tubal ectopic pregnancy., Design: Between January 1998 and September 2008, we retrospectively reviewed 219 tubal ectopic pregnancy patients who were hospitalized. The patients using contraceptive methods, underwent previous pelvic or tubal surgery, pregnancy after in vitro fertilization, over the age of 28, and extratubal ectopic pregnancies were excluded. Patients who actively attempted to conceive were included. We called all the patients to see whether they had pregnancy in 24 months, and how long they had waited for this after the operation. Overall, we could not reach 14 patients who were treated surgically (n = 9) or medically (n = 5)., Setting: Department of Obstetrics and Gynecology, Ege University, Izmir, Turkey., Participants: Women aged between 18 and 28 years that were treated because of tubal ectopic pregnancy and have concerns about infertility., Interventions: Medical treatment with methotrexate (n = 34), salpingectomy (n = 62) salpingostomy (n = 37)., Main Outcome Measures: Intrauterine pregnancy rates, ectopic pregnancy rates and mean time to pregnancy after interventions., Results: After questionnaire: in the methotrexate group; six of 29 (20%) had no pregnancy; 23 (79%) of them conceived, but three (10%) of the pregnancies were extrauterine. Thirty-seven patients received salpingostomy and 62 patients composed the salpingectomy group. Intrauterine pregnancy rates up to 24 months were established as 65.2% in salpingectomy (n = 55) and 60.1% in the salpingostomy (n = 35) groups respectively. No significant difference was noticed when pregnancy rates were compared among three groups (P = 0.942). Mean time to pregnancy in methotrexate group was 7.8 ± 2.2 months, and in salpingostomy and salpingectomy groups was 8.7 ± 2.2 and 9.3 ± 3.1 months respectively (P = 0.841)., Conclusion: Since we found no difference in terms of pregnancy rates among three groups, medical treatment appears to be more favored with early and accurate diagnosis. After salpingectomy, patients may conceive later in life when compared with other groups so selected patients should be assessed according to their age for the decision of assisted reproductive techniques., (Copyright © 2011 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Objective: To report our experience with isobaric (gasless) transumbilical laparoendoscopic single-site (LESS) surgery in 100 patients with adnexal tumors at a single center., Study Design: In each case, a wound retractor was used as a working port through a 2.5-cm vertical umbilical incision. The surgical view was secured with the subcutaneous abdominal wall-lift method. Surgical procedures were performed using conventional laparoscopic instruments under vision with a rigid 30°, 5-mm EndoEYE laparoscope. Clinical data regarding patient demographics and surgical outcomes were retrospectively analyzed., Results: Between August 2009 and July 2010, one hundred and seventeen tumors from 100 cases were treated with isobaric LESS surgery (unilateral salpingo-oophorectomy, 46; unilateral cystectomy, 33; bilateral cystectomy, 8; bilateral salpingo-oophorectomy, 6; unilateral cystectomy and contralateral cyst wall ablation, 4; unilateral cystectomy and contralateral salpingo-oophorectomy, 2; and unilateral salpingectomy, 1). Three normal adnexa were prophylactically resected at the same time as contralateral salpingo-oophorectomy of a diseased ovary. Previous abdominal surgery was noted in 20 cases. Emergency surgery was performed in 7 cases. Six pregnant women were treated in the late first trimester. Median tumor diameter was 6.9 cm. Median surgical duration was 55 min and median blood loss was 10 mL. Conversion to conventional laparoscopic surgery was noted in one case of recurrent endometriotic cyst with severe adhesion. Laparotomic conversion was not experienced. Prolonged administration of antibiotics with extended hospitalization was required in 7 cases due to elevated inflammatory parameters. There were no major surgical complications in this series. The technique yielded excellent cosmetic results with minimum postoperative scar concealed within the umbilicus. With exclusion of 4 endometriotic cysts treated with cyst wall ablation, pathological diagnosis was obtained for 113 tumors (dermoid cyst, 54; endometriotic cyst, 21; serous cystadenoma, 19; mucinous cystadenoma, 9; paraovarian cyst, 8; serous borderline tumor, 1; and paraovarian serous papillary borderline tumor, 1)., Conclusions: With efficient wound retraction to create a wide and flexible orifice during instrumentation, the transumbilical wound retraction system combined with the subcutaneous abdominal wall-lift method contributes favorably to LESS surgery as a safe, feasible and reproducible alternative for a variety of ablative and reconstructive applications in the management of adnexal tumors., (Copyright © 2011 Elsevier Ireland Ltd. 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.)

Introduction: Laparoscopic ureterolysis is a delicate procedure that requires advanced laparoscopic skills., Materials and Methods: We are reporting two cases of laparoscopic hysterectomy and salpingo-oophorectomy with severe adhesions to the pelvic sidewall that required ureterolysis and describing a modified technique suitable for the laparoscopic performance of this procedure., Results: In more than 15 years of doing laparoscopic ureterolysis to deal with various gynecological cases, we have never had a ureteral injury related to the ureterolysis procedure. There have been uterine artery lacerations, usually when trying to apply clips for uterine artery ligation in which case the artery can be compressed with a clamp until it is reclipped, bipolar-cauterized or suture-ligated using intracorporeal knot tying. However, we did not have a single patient that required open surgery because of these lacerations., Conclusion: Because of the advantage of magnified viewing and laparoscopic dissection techniques which control small vessel bleeding, the laparoscopic route for ureterolysis is far easier to use than its open counterpart once it is learned. Laparoscopy, in addition, offers the added advantages of shorter hospital stay, reduced patient pain, reduced transfusion requirements and far better cosmetic results.

Background: Risk-reducing salpingo-oophorectomy (RRSO) is the safest intervention for prevention of ovarian cancer in women at increased risk for hereditary breast-ovarian cancer. Little is known about other effects of RRSO. The objective of this study was to investigate quality of life (QoL) and fatigue in a sample of women who had RRSO for increased cancer risk and to compare the findings with those of age-matched controls from the general population (NORM)., Materials and Methods: In a cross-sectional follow-up mailed questionnaire design, 301 (67%) of 450 invited Norwegian women with RRSO attended. The questionnaire contained measures of QoL, fatigue, anxiety/depression, and body image, and questions about demography, lifestyle, and morbidity. The findings were compared with those of the NORM., Results: For RRSO women, mean age at survey was 53.7 years (SD, 9.2), mean age at RRSO was 48.4 years (SD 8.4), and median follow-up time was 5.0 years (range, 1-15 years). No clinically significant differences were observed between RRSO and NORM for any of the QoL or fatigue dimensions. In subgroup analyses of the RRSO group, no clinically significant differences in QoL and fatigue were observed between those who had surgery before or after age 50 years, or between BRCA1/2 carriers and women with unknown mutation statuses. Women who had cancer (32%), however, showed clinically significant lower levels of QoL and more fatigue than women without cancer., Conclusions: Women who had RRSO showed similar levels of QoL and fatigue as NORM. Women who had cancer before RRSO had lower levels of QoL and more fatigue.

Background: To evaluate the effectiveness of surgery, medical treatment and expectant management of tubal ectopic pregnancy (EP) in terms of treatment success (i.e. complete elimination of trophoblast tissue), financial costs and future fertility., Methods: We searched for randomized controlled trials which described treatment interventions that have been widely adopted in clinical practice. A systemic literature search identified 15 trials., Results: Laparoscopic salpingostomy was significantly less successful than the open surgical approach (relative risk, RR 0.9, 95% CI 0.82-0.99) due to a higher persistent trophoblast rate, but was significantly less costly. A prophylactic single shot methotrexate (MTX), given intramuscularly (i.m.) immediately post-operatively, significantly reduced persistent trophoblast after laparoscopic salpingostomy (RR 0.89, 95% CI 0.82-0.98, number needed to treat of 10). With systemic MTX in a fixed multiple dose i.m. regimen the likelihood of treatment success was higher than with laparoscopic salpingostomy (RR 1.15, 95% CI 0.93-1.43), but the difference was not significant. Systemic MTX in a fixed multiple dose i.m. regimen was only cost-effective if serum human chorionic gonadotrophin (hCG) concentrations were <3000 IU/l. If serum hCG concentrations were <1500 IU/l, then the single-dose MTX i.m. regimen-if necessary with additional MTX injections-was also cost-effective. Expectant management could not be evaluated yet. Subsequent fertility did not differ between the interventions studied., Conclusions: This meta-analysis shows that laparoscopic surgery is the most cost-effective treatment for tubal EP. Systemic MTX is a good alternative in selected patients with low serum hCG concentrations.

Background: Ectopic pregnancy occurs more in young women who still desire children. Because of tubal rupture, salpingectomy which leads to tubal loss and reduced reproductive potentials is the commonest management option. This is a case report of a primipara who had ruptured left tubal ectopic pregnancy managed by salpingectomy and later had unruptured heterotopic pregnancy involving the contralateral tube and managed by salpingostomy, after which she had spontaneous abortion of the associated intrauterine pregnancy., Result: Initial marital disharmony, followed by an uneventful intrauterine pregnancy carried to term with caesarean delivery of a live female baby., Conclusion: In well-selected cases, conservative tubal surgeries should be encouraged in preference to radical surgeries in the management of unruptured tubal pregnancies.

Background: For most tubal ectopic pregnancies (EP) surgery is the treatment of first choice. Whether surgical treatment should be performed conservatively (salpingostomy) or radically (salpingectomy) in women wishing to preserve their reproductive capacity, is subject to debate. Salpingostomy preserves the tube, but bears the risks of both persistent trophoblast and repeat ipsilateral tubal EP. Salpingectomy, avoids these risks, but leaves only one tube for reproductive capacity. This study aims to reveal the trade-off between both surgical options: whether the potential advantage of salpingostomy, i.e. a better fertility prognosis as compared to salpingectomy, outweighs the potential disadvantages, i.e. persistent trophoblast and an increased risk for a repeat EP., Methods/design: International multi centre randomised controlled trial comparing salpingostomy versus salpingectomy in women with a tubal EP without contra lateral tubal pathology. Hemodynamically stable women with a presumptive diagnosis of tubal EP, scheduled for surgery, are eligible for inclusion. Patients pregnant after in vitro fertilisation (IVF) and/or known documented tubal pathology are excluded. At surgery, a tubal EP must be confirmed. Only women with a tubal EP amenable to both interventions and a healthy contra lateral tube are included. Salpingostomy and salpingectomy are performed according to standard procedures of participating hospitals. Up to 36 months after surgery, women will be contacted to assess their fertility status at six months intervals starting form the day of the operation. The primary outcome measure is the occurrence of spontaneous viable intra uterine pregnancy. Secondary outcome measures are persistent trophoblast, repeat EP, all pregnancies including those resulting from IVF and financial costs. The analysis will be performed according to the intention to treat principle. A cost-effectiveness analysis will be performed within a decision analysis framework, based on costs per live birth, including IVF treatment whenever a spontaneous pregnancy does not occur. Patients' preferences will be assessed using a discrete choice experiment., Discussion: This trial will provide evidence on the trade off between salpingostomy and salpingectomy for tubal EP in view of the pros and cons of both interventions and will offer guidance to clinicians in making the right treatment choice., Trial Registration: Current Controlled Trials ISRCTN37002267.

Ectopic pregnancy is a major gynecologic emergency, which results in significant morbidity for the mother and inevitable loss of the pregnancy. Its presentation can be varied from minor symptoms to sudden collapse. It produces a diagnostic dilemma and a management problem. With advances in medical care, most women survive ectopic pregnancy and many will be diagnosed early enough to allow conservative management with the resulting lower morbidity and possible anatomic conservation. This article covers what is currently known about the etiology of this condition, the best approach to the diagnoses and management and the long-term consequences for the women concerned.

Objective: This study was undertaken to examine surgical management of patients with ovarian remnant syndrome., Study Design: Data were abstracted from records of patients with a history of bilateral salpingo-oophorectomy who were treated surgically at Mayo Clinic between 1985 and 2003 for pathologically confirmed residual ovarian tissue. A follow-up questionnaire was also mailed., Results: Records review identified 186 patients (mean age, 37.6 years; mean follow-up, 1.2 years). Of 180 patients with available data, 153 (85%) underwent oophorectomy by laparotomy, 13 (7%) by laparoscopy, and 14 (8%) by transvaginal approach, mostly for endometriosis (56.8%). Of 186 patients, 105 (57%) presented with pelvic masses and 89 (48%) with pelvic pain. Remnant ovarian tissue was associated with a corpus luteum in 78 (42%) and endometriosis in 54 (29%). The intraoperative complication rate was 9.6%. Of 142 patients, 12 (9%) required subsequent re-exploration (1 ovarian remnant identified)., Conclusion: This heavily pretreated population has modest risk of bowel, bladder, or ureteral trauma with definitive pelvic sidewall stripping and apical vaginal excision. However, subsequent recurrence is minimal (<1%). More than 90% of patients reported resolution or marked improvement of symptoms.

Postoperative ascites is a rare and serious complication of laparoscopic procedures. Urinary tract injury, bowel injury, and lymph duct injury are the common causes; however, in some patients no definitive cause can be identified after an extensive diagnostic work-up. We present a case of postoperative ascites of unknown origin. The patient recovered with general treatments. We presume that diffuse peritoneal injury may have been caused by unidentified substances in our patient.

Study Objective: To evaluate the chance of adhesion formation after laparoscopic salpingo-ovariolysis and determine the efficacy of early second-look laparoscopy (SLL)., Design: Prospective, randomized study (Canadian Task Force classification I)., Setting: Shiraz University hospitals., Subject: Ninety women with mean duration of infertility of 7.2 years., Interventions: Operative laparoscopy, with early SLL with adhesiolysis in 46 (group 1) and no SLL in 44 women (group 2)., Measurements and Main Results: Adnexal adhesions were evaluated according to American Society for Reproductive Medicine adhesion classification. Separation of newly reformed adhesions was performed at the time of SLL. Patients were followed for a year after operation without other infertility treatment. At the time of operation in group 1, adnexal adhesions were graded as severe (class D) in 19 women, moderate (class C) in 31, mild (class B) in 28, and minimal (class A) in 14. Respective figures in group 2 were 10, 30, 34, and 14. After salpingo-ovariolysis these figures were 12, 10, 20, and 50 in group 1 and 6, 14, 17, and 51 in group 2. In group 1 in whom early second-look laparoscopy was performed, at the start of the operation these figures were 17, 20, 21, and 34, and after operation 12, 8, 20, and 52, respectively. There were 11 term pregnancies in group 1 and 15 in group 2. No women with severe adhesions in either group conceived. In group 1, chances of term pregnancy were 18.75% for those with moderate adhesions, 35.71% for women with mild adhesions, and 42.86% in patients with minimal adhesions. Respective figures in group 2 were 26.67%, 41.18%, and 57.14%., Conclusion: The chance of moderate and severe adhesion reformation after laparoscopic salpingo-ovariolysis was 40.2%. Although separation of these adhesions could be performed more easily at the time of early SLL, the chance of pregnancy did not increase compared with that in patients who did not undergo SLL.

Background: In this era of cost containment, laparoscopic management of ectopic pregnancy has become the mainstay of dealing with this common gynecologic emergency. The aim of surgical intervention remains conservation of the fallopian tube, if possible; salpingectomy is reserved for cases of tubal rupture and/or recurrent ectopic pregnancy, where little hope exists of salvaging tubal function., Case: A 28-year-old woman, para 2, underwent laparoscopic salpingostomy for ectopic pregnancy. She experienced intraabdominal bleeding within the initial 12 hours of the postoperative period. On exploratory laparotomy, there was active bleeding from the site of the salpingostomy, and a salpingectomy was performed. The patient was lost to follow-up and on postoperative day 21 presented with signs of intraabdominal bleeding; repeat laparotomy revealed active bleeding from trophoblastic implants within the greater omentum. The omentum was adherent to the anterior abdominal wall at the site of umbilical trocar placement. An infracolic omentectomy was performed, with a subsequent uneventful postoperative course; the patient was followed until resolution of the serum beta-hCG., Conclusion: Postoperative surveillance is important. Positive intraabdominal pressure during laparoscopic surgery and the Trendelenburg position may be contributory to cephalad migration of trophoblast remnants, with the scavenging action of the omentum and adherence to the site of umbilical trocar placement theoretically providing a mechanism for neovascularization and sustenance of the parasitic trophoblast.

Study Objective: To investigate whether frequency of persistent ectopic pregnancy after linear salpingotomy can be reduced by prophylactic administration of a single intraoperative injection of local methotrexate., Design: Prospective, randomized, controlled trial (Canadian Task Force classification I)., Setting: University-affiliated hospital., Patients: Sixty-five women with unruptured ectopic pregnancy., Intervention: Laparoscopic salpingotomy with or without a single intratubal dose of methotrexate 1 mg/kg., Measurements and Main Results: In the prophylaxis group, 22 patients received a single dose of intratubal methotrexate 1 mg/kg after linear salpingotomy; 43 controls had only linear salpingotomy. Six women (14%) in the control group developed persistent ectopic pregnancy, compared with none in the prophylaxis group (p <0.05)., Conclusion: In our opinion, intratubal methotrexate injection during laparoscopic salpingotomy is a practical option for women with unruptured ectopic pregnancy.

Study Objective: To estimate the association between preoperative beta-human chorionic gonadotropin (hCG) and progesterone levels, and success of linear salpingostomy in treatment of tubal pregnancy., Design: Retrospective case control study (Canadian Task Force classification II-1)., Setting: Women's general hospital., Patients: Three hundred five women undergoing laparoscopic linear salpingostomy for ectopic pregnancy., Intervention: Examination of risk factors for surgical failure of salpingostomy by analyzing corresponding receiver operating curves., Measurements and Main Results: In 305 women, intervention was successful in 272 and failed in 33, as assessed by either postoperative hemorrhage (16) or rising beta-hCG values (14); 3 women had both. Of 295 patients in whom beta-hCG was evaluated preoperatively, 149 (50.5%) had values of 1000 mU/ml. or less; 75% had progesterone levels of 10 ng/ml or below. No association was found between preoperative beta-hCG and progesterone levels and the success of linear salpingostomy., Conclusion: Preoperative beta-hCG and progesterone levels are of no significance with regard to success of linear salpingostomy for treatment of tubal pregnancy.

Objectives: The effect of adnexal surgery on ovarian function is a controversial issue of high clinical significance. The purpose of this study was to assess the effect of adnexal surgery on ovarian function., Study Design: All patients who underwent adnexal surgery in our department during an 8-year period (all records were obtained from the hospital database between January 1991 and December 1998) were cross-matched with our in vitro fertilization (IVF) database. We compared the baseline hormonal levels and the patients' response to IVF stimulation (assessed by the total amount of gonadotropins, maximal estradiol (E2) levels, number of retrieved and fertilized oocytes)., Results: Sixty-four consecutive patients who underwent adnexal surgery were compared with 68 matched controls. Neither of the analyzed parameters were affected by the tubal surgery., Conclusions: We conclude from our study adnexal surgery is not detrimental to ovarian function.

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: The aim of this study was to analyze the fertility prognosis after conservative or radical surgery for ectopic pregnancy. Also, to identify any biological factors that may influence the fertility outcome after an ectopic pregnancy., Methods: A retrospective study which was carried out by collating information from the patient's hospital records was performed on 137 cases of confirmed ectopic pregnancy between January 1990 and December 1995 at the Security Forces Hospital Riyadh, Kingdom of Saudi Arabia. The outcome measure of term pregnancy rate and repeat ectopic pregnancy rate was analyzed up to 3 years after the diagnosis of index ectopic pregnancy., Results: Our results showed that the term pregnancy rates were not significantly different following radical or conservative surgical treatments for ectopic pregnancy, P > 0.05, (50% in the conservative group compared with 56% in the radical group). But equally important, the risk of a further ectopic was not increased in the radical surgery group, P >0.05 (11% in the conservative group as compared to 8% in the radical group). The incidence of intrauterine pregnancy rate (term pregnancy + miscarriage) was also comparable in each group. Multivariate regression analysis showed that the factors associated with higher fertility were age 30 years or less, past history of term pregnancy and a negative history of infertility (P < 0.05)., Conclusion: No significant difference in intrauterine pregnancy rates or repeat ectopic pregnancy rates were found after radical or conservative surgical treatment for tubal pregnancy. The patient's age, previous obstetric performance and a history of infertility significantly influenced fertility following the index ectopic pregnancy.

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.

Extratubal secondary trophoblastic implants (ESTI) are a rare complication of conservative laparoscopic procedures for tubal ectopic pregnancies. These implants present with persistent beta-hCG titers postoperatively and are probably the result of disruption of the ectopic pregnancy at salpingostomy or morcellation of the fallopian tube at salpingectomy. We describe the case of a 32-year-old woman who underwent a laparoscopic salpingectomy for a tubal ectopic pregnancy that was complicated postoperatively by peritoneal ESTI including extensive omental implants. Intraoperatively the lesions appeared as 0.3 cm red-black nodules and, microscopically, consisted of degenerating chorionic villi associated with implantation changes in the surrounding tissue. To the pathologist unaware of the clinical entity of ESTI, these lesions may present a diagnostic challenge.

Salpingostomy has gradually replaced salpingectomy as the surgical procedure of choice for unruptured tubal pregnancy in women who wish to preserve fertility. There are no prospective studies and only a few retrospective reports comparing fertility rates after salpingostomy and salpingectomy. Three major retrospective studies found no significant difference in fertility or incidence of repeat ectopic pregnancy between the two procedures, but salpingostomy carries a 5-8% risk of persistent ectopic pregnancy, contributing to increased morbidity and cost. There are approximately 109,000 ectopic pregnancies per year in the United States. If half are treated by salpingostomy, 54,500 women will need serial beta-hCG testing after surgery. Approximately 3543 will have a persistent ectopic pregnancy requiring surgical or medical treatment. The additional direct costs created by persistent ectopic pregnancy is estimated to be almost $16,000,000. Fertility after ectopic pregnancy is affected much more by the status of the contralateral tube than by the procedure performed, with fertility rates exceeding 80% after salpingectomy when the opposite tube is normal. By performing salpingectomy when the contralateral tube is normal, half the additional cost and morbidity could be avoided without jeopardizing subsequent fertility.