[Laparoscopic management of extrauterine pregnancy]

The radioimmunologic assay of human chorionic gonadotropin and ultrasound have contributed to an earlier diagnosis of ectopic tubal pregnancy. Laparoscopy has modified not only diagnostic, but even therapeutic approach. In fact laparoscopic approach and medical treatment with methotrexate have proved to be safe and effective. Between October 1991 and December 1993 by the Department of Obstetric and Gynecology of the Hospital Felice Villa (Mariano Comense -- CO) all patients (14) with suspected extra-uterine pregnancy were submitted to laparoscopy. Of these 12 were treated by laparoscopic salpingostomy or aspiration. Five cases in which trophoblastic tissue was not present at histologic specimen were submitted to medical treatment with methotrexate. In 2 cases in which the tube was ruptured we performed a salpingectomy after laparotomy. We didn't have any early or late complication. After laparoscopy betahCG levels were monitored every 2 days. We didn't have any case of trophoblastic persistency or any recurrence. Recent studies have demonstrated lower morbidity and higher fertility rate in women treated laparoscopically for GEU. However data from literature show some discrepancy. As a matter of fact it is not so evident that fertility is better preserved by operative laparoscopy than laparotomy. Anyway laparoscopy presents a better outcome for the patient and requires less days of hospitalization.