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Effect of second-look laparoscopy on subsequent fertility outcome after laparoscopic salpingostomy for tubal
Zhengyu Li1, Jin Liu1, Wenjiao Min2
1Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.
Objective:
To clarify the potential value of second-look laparoscopy (SLL) in improving fertility outcomes after laparoscopic salpingostomy for tubal pregnancy.
Design:
Randomized controlled trial.
Setting:
West China Second University Hospital, Sichuan University.
Patients:
216 women with future birth demand who underwent laparoscopic salpingostomy for tubal pregnancy.
Interventions:
SLL was performed in the SLL group at 3 months after the primary surgery.
Measurement And Main Results:
In both the SLL and control groups, the subjects were assigned to a slight adhesion (SLA) or severe adhesion (SEA) subgroup. At 3-year follow-up, the fertility outcomes were compared between the SLL and control groups and also between the SLA and SEA subgroups. The intrauterine pregnancy rate was higher in the SLL group compared with the control group (63.1% vs 48.6%; p = .032), and the incidence of recurrent ectopic pregnancy was lower in the SLL group than in the control group (6.3% vs 16.2%; p = .021). In the control group, the cumulative pregnancy rate was higher in the SLA subgroup compared with the SEA subgroup (p = .017), but in the SLL group, the cumulative pregnancy rate did not differ between the 2 subgroups (p = .502). The cumulative pregnancy rate was higher in the SEA subgroup of the SLL group compared with the SEA subgroup of the control group (p = .014), but did not differ between the SLA subgroup of the SLL group and the SLA subgroup of the control group (p = .456).
Conclusion:
SLL may improve subsequent fertility outcome after laparoscopic salpingostomy for tubal pregnancy, and may be especially recommended for women with severe and extensive pelvic adhesions.
