Conservative microsurgical management of ectopic gestation

The current management of ectopic gestation has been greatly affected by two apparent trends: a world-wide dramatic increase in its incidence; and a tendency for women to delay childbearing into later life. In the past, the objective of surgery for ectopic pregnancy was saving lives, and salpingectomy was the procedure of choice. At present, with improved methods of an early diagnosis, namely quantitative beta-HCG, ultrasonography, and laparoscopy, preservation of maximal reproductive potential of the affected women becomes a primary surgical goal. Conservative microsurgical approach with the reconstruction of the affected oviduct may be the procedure of choice. Following standard salpingectomy for ectopic gestation, two-thirds of such patients will not subsequently reproduce successfully. On the other hand, statistics indicate that microsurgical repair of the affected oviduct at the time of operation for an ectopic pregnancy will be followed by term pregnancy in 50 to 72% of patients. In this presentation, a variety of conservative surgical approaches are described and discussed. They represent a spectrum from operative laparoscopy to laparotomy with linear salpingotomy, segmental excision with or without an immediate anastomosis, to the management of tubal abortion. General principles of microsurgical techniques applicable to the management of unruptured ectopic gestation are outlined. The analysis of available data indicate that conservative approach is advantageous for preservation and enhancement of future reproductive potential of the affected patient. Since ectopic tubal gestation is an unqualified human reproductive disaster, preservation and restoration of normal pelvic architecture appears logical and applicable, especially in cases of chronologically older women whose first pregnancy is an ectopic location.