Surgical Treatment
Until the last 20 years, ectopic pregnancies usually were treated by total salpingectomy (removal of the entire tube [Fig. 2]) via laparotomy (major abdominal surgery). Today, most surgeries for ectopic pregnancies are
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performed by laparoscopy. Laparotomy usually is reserved for those ectopic pregnancies that have ruptured, causing severe internal bleeding, or when there is extensive scar tissue inside the abdomen and pelvis.
If the ectopic pregnancy is diagnosed early, before the tube ruptures, a laparoscopic salpingostomy may be performed. In this procedure, the fallopian tube is opened and the pregnancy tissue is removed while leaving the tube in place (Fig. 3). The tube then heals on its own. In about 5% to 15% of cases, some of the ectopic tissue may remain and continue to grow. This may be treated by additional surgery to remove the tube or by using methotrexate therapy. A partial salpingectomy (sometimes called a segmental resection, to remove a middle segment of the tube [Fig. 2]) may be performed when the ends of the tubes (the fimbriae) appear healthy and the ectopic pregnancy is small. If only a small portion of the tube is removed, the tube may be rejoined later using microsurgery. If the fallopian tube is extremely damaged, the ectopic pregnancy is large, or the woman is bleeding excessively, a total salpingectomy is performed. In rare cases when the ectopic pregnancy involves the ovary, a portion of the ovary or the entire ovary may be removed.