Laparotomy or laparoscopic surgery? Factors affecting the surgeons choice for the treatment of ectopic pregnancy

In this study, we aim to compare the surgeons' choice on the ectopic pregnancy cases during the last four years. The differences between laparoscopy and laparotomy cases and the factors which directed the surgeon to choose either of the surgical methods were evaluated.

Our study comprises 135 patients who were diagnosed as ectopic pregnancy and were hospitalized in the Gynecology Department of Istanbul Medical Faculty during 1996-1999.

During 1996-1999 a total of 118 cases had been diagnosed as tubal ectopic pregnancy and had been treated surgically. Seventy three patients (62%) had been treated with laparotomy while the rest 45(38%) had been treated laparoscopically. When compared, the amount of intraabdominal free blood volume was significantly higher in laparotomy group [270.45 +/- 466.72 mL laparoscopy group - 889.75 +/- 714 mL laparotomy group, (p = 0.0001)]. When we considered haemoperitoneum amount according to the patients' parity, intraabdominal blood volume was interestingly higher in multiparas [507 +/- 599.32 mL nulliparas vs. 768.68 +/- 749.15 mL mulltiparas, (p = 0.044)]. The percent of cases with ruptured tubes was 64% for the laparotomy and 38% the laparoscopic cases; and the difference between two groups was significant (p = 0.0013).

Our study implied that haemodynamic stability and less intraabdominal free blood affect the surgeons' decision between laparotomy and laparoscopy. Fewer multiparous patients are suitable for these criteria which leads to less laparoscopic surgery. These findings, which need to be clarified, lead to the idea of human factor affecting the surgeons' choice indirectly.