Conservative surgical treatment of ectopic pregnancy. Avoiding partial salpingectomy

Salpingostomy is the preferred surgical method of managing ectopic gestation when patients desire future fertility. Problems with that technique stem principally from difficulties with hemostasis. While ligation of a single mesosalpingeal vessel has been described, blood to the site of the ectopic gestation is supplied primarily by the tubal branch of the ovarian artery. We developed a technique for ligating that vessel at both ends of the ectopic site. The technique may be combined with mesosalpingeal vessel ligation and leads to excellent hemostasis. Although blood vessels to the tube are interrupted, tubal length is preserved. Salpingostomy is thus possible, even in cases of large, actively bleeding or ruptured ectopic gestations. The need for partial salpingectomy, frequently utilized under those circumstances, is thus obviated. Salpingostomy may result in spontaneous recanalization; if anastomosis is needed subsequently, maximal tubal length is preserved.