Randomised trial of systemic methotrexate versus laproscopic salpingostomy
in tubal pregnancy.
Although most tubal pregnancies are managed successfully with salpingectomy or salpingostomy
, additional measures may be required to control bleeding.
Her previous history included: (1) spontaneous delivery at 38 weeks of gestation 12 years ago; (2) laparoscopic salpingostomy
due to hydrosalpinx; and (3) endometriosis diagnosed by laparoscope.
Most authors agree that the size of cornual gestation determines the best laparoscopic approach; Tulandi  reported that salpingostomy
is appropriate for gestations of <3.5cm, whereas cornual excision was recommended by Grobman et al.
Medical therapy involves methotrexate and surgical choices include salpingostomy
or salpingectomy either laparoscopically or laparotomically.5
Small published reports and case series have documented the use of laparoscopic bilateral salpingectomy (BS) with and without hysterectomy, laparoscopic BS with cornuectomy, and laparoscopic salpingostomy
, often followed by salpingectomy.
It is caused by the dissemination of endometrial tissue into the wound at the time of surgery.2 Scar endometriosis can occur after prior abdominopelvic surgeries and interventions such as hysterotomy, salpingostomy
, episiotomy, caesarean section (C-section), appendectomy, amniocentesis and laparoscopy.2,3 The deposits can involve uterine scar, abdominal musculature or subcutaneous tissue with the latter being the most common site of extragenital endometriosis.4 Estimated incidence after caesarean delivery is 0.03-0.4% and may reach up to 1.08% after hysterotomy.3,5 The endometrial implant may be cystic, solid or mixed5 It usually presents as a palpable mass at the scar site with or without cyclical pain.2,6-8
Accordingly, the available marked adhesive process in the small pelvis causes a need in salpingo-ovariolysis, salpingostomy
, and fimbriolysis in time of the laparoscopy treatment.
, in which the tube is not removed, is similarly defensible, because the intention is to remove the woman's damaged tubal tissue and the damaging trophoblastic tissue (e.g., by use of methotrexate), not to kill or destroy the embryo.
Pregnancy rates after operative endoscopic treatment of total (neosalpingostomy) or near total (salpingostomy
) distal tubal occlusion.
Left salpingectomy and right salpingostomy
She has a history of salpingostomy
for an ectopic pregnancy and has undergone a Roux-en-Y gastric bypass procedure.