Fertiliteit na behandeling wegens extra-uteriene graviditeit: evaluatie van de overgang van laparotomie naar laparoscopie

Evaluation of the switch in surgical treatment for ectopic pregnancy from laparotomy to laparoscopy at the Sophia Hospital, Zwolle, the Netherlands.

Design

Retrospective.

Method

Initially an ectopic pregnancy was treated by means of laparotomy at the Sophia Hospital, Zwolle, the Netherlands. At the end of 1996 laparoscopic treatment became the method of first choice. In 2003, all patients who received surgical treatment for ectopic pregnancy in the period 1995-2001 were evaluated. As well as examining their medical records, all patients were questioned about the fertility outcome since the ectopic pregnancy. All of the patients could be traced and the response was 100.

Results

In the study period 97 patients were operated on due to an ectopic pregnancy. The admission period was significantly shorter after laparoscopy compared to laparotomy. The complication rate in both groups was low. In total 78 (80) of the patients still wanted to conceive. During the observation period, 94 pregnancies occurred in 61 patients. The pregnancy rates following laparotomy and laparoscopy were the same. After salpingostomy, the future fertility was significantly higher (p < 0.05) compared to salpingectomy.

Conclusions

A laparoscopic treatment of ectopic pregnancy is more advantageous for the patient compared to laparotomy: in our results this did not compromise future fertility. Salpingostomy was associated with an increased chance of later pregnancy compared to salpingectomy.

Ned Tijdschr Geneeskd 2005;149:407-12