Saving the pipe
Indications for salpingotomy: ovum up to 3–4 cm, no rupture, healthy or absent second tube, desire for pregnancy. The surgeon coagulates the incision site, opens the tube and removes pregnancy tissue in a container, rinses the tube; bleeding is stopped by targeted coagulation. The risk of persistence of trophoblast (remaining cells) is 5–10% - therefore hCG is monitored weekly, and if there is a plateau, methotrexate is prescribed. The patency of the preserved tube is restored in 80%, but the risk of recurrent ectopic ectopia in it is 15–20%; If the second tube is healthy, many surgeons recommend tubectomy.
Indications
- tubal pregnancy - progressive or disturbed (tubal abortion, tubal rupture) according to ultrasound and hCG;
- intra-abdominal bleeding due to a pipe rupture - emergency surgery;
- hydrosalpinx, pyosalpinx, irreversibly changed tube, recurrent tubal pregnancy in the same tube (tubectomy);
- removal of tubes before IVF for hydrosalpinx.
Save or delete pipe
With a progressive tubal pregnancy of small size in a woman who wants to preserve fertility, and with a healthy second tube, organ-preserving salpingotomy is possible; in case of a rupture, a large ovum, a repeat pregnancy in the same tube, a destroyed wall and a healthy second tube, tubectomy is preferable - it excludes a repeat ectopic in this tube and does not reduce the chances of a natural pregnancy with a intact second tube. Both options are performed laparoscopically, even with intra-abdominal bleeding in a stable condition; The removed tissue is examined histologically, hCG is controlled to zero.
Benefits of laparoscopy
Laparoscopy is the standard of modern operative gynecology: magnifying the image by 10–15 times allows you to work more accurately than an open operation and is more gentle on the ovarian tissue and tubes, blood loss is minimal, adhesions form less frequently (important for future pregnancy), the pain after the operation is mild, and the patient gets up on the day of the operation and is discharged on the 1st–3rd day; Instead of a cut, three barely noticeable scars remain. In the clinics below, laparoscopic operations are performed by gynecological surgeons with extensive experience on modern endoscopic stands.
Risks and contraindications
- rare complications: bleeding, injury to neighboring organs, infection, thrombosis - prevention and the experience of the surgeon reduce the risk to a minimum;
- contraindications: severe heart and lung diseases, coagulation disorders, severe adhesions after many operations, large tumors (>15–20 cm) - then laparotomy is chosen;
- Obesity and previous operations are not a contraindication, but require an experienced team.
