A review of laparoscopy and laparotomy in the management of tubal pregnancy.

A retrospective review was performed of all women who had undergone operation for a tubal pregnancy at the Prince of Wales Hospital, Hong Kong, from November 1992 to March 1994. One hundred and five patients were included---61 were managed by laparoscopy and 44 by laparotomy. There were no differences in age, parity, gestational age, frequency of previous ectopic pregnancy, or laparotomy between the two groups. Sixty per cent of patients in the laparotomy group had a diagnostic laparoscopy prior to the laparotomy. The laparoscopy group had a lower incidence of haemoperitoneum (45.9% vs 75.0%, P<0.05). There was no difference in the mean operating time. The laparoscopic approach was associated with a significant reduction in: intra-operative blood loss (46.7plus minus76.8 mL vs 213.4plus minus149.3 mL. P<0.001), post-operative analgesia requirement (odds ratio 0.08, 95% CI, 0.02-0.32), post-operative morbidity (odds ratio 0.27, 95% CI, 0.12-0.58), length of hospital stay (2.9plus minus2.2 days vs 5.1plus minus1.2days, P<0.001) and recuperation period (11.0plus minus9.3days vs 21.7plus minus8.5 days, P<0.001). Operative laparoscopy has the advantage of combining diagnostic and therapeutic procedures in a single operation, and is a better approach than laparotomy in the management of tubal pregnancy.