Objective— To compare operativc laparoscopy with laparotomy for the management of ectopic pregnancy in haemodynamically stable women.
Design— Non-randomized prospective cohort study, treatment allocation depending on the surgical preference and experience of the on-call medical team.
Setting— Provincial undergraduate teaching hospital.
Subjects— 87 consecutive and unselected haemodynamically stable women treated for ectopic pregnancy bctween 1 March 1988 and 31 August 1989.
Interventions— Salpingotomy, salpingectomy, salpingo-oophorectomy or simple extraction of the ectopic pregnancy depending on its site, size and nature performed under laparoscopic control or laparotomy.
Main outcome measures— Operative outcome, duration of surgery, intra- and post-operative complications, post-operative hospital stay, return to normal domestic activities. return to work, changes in plasma β-hCG concentrations, health and social service costs.
Results— 60 women were treated by videopelviscopy on 65 occasions and the othcr 27 were treated by laparotomy. The two groups were similar for age, parity and gestation at presentation. Of the 65 operative laparoscopies 61 (94%) were successful and all 27 laparotomies were completed uneventfully. Whereas the operating time was similar in the two groups, 55.3 and 51.1 min for videopelviscopy and laparotomy respectively, operative laparoscopy was associated with significantly shorter post-operative hospital stay (1.7 vs 5.2 days), faster return to domestic activitics (1.5 vs 3.3 weeks) and work (2.5 vs 5.7 weeks) (P<0.001 for all). In economic terms, successful vidcopelviscopy was associated with a reduction in hospital accommodation costs by 69% (£248 vs£808), drug costs by 52% (£8.38 vs£17.57) and statutory sickness payment by 51% (£130.25 vs£266.51), that is an overall saving to the health and social services of £701.47 or 50% per ectopic pregnancy (P<0.001).
Conclusions— Operative laparoscopy can be used to successfully treat most cases of extrauterine pregnancy with advantages over laparoscopy in terms of reduced hospitalization, faster recovery and lower health service costs.