Laparoscopic salpingostomy: tube-saving surgery for an ectopic pregnancy

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An ectopic pregnancy is a pregnancy that has settled outside the womb, most often in a fallopian tube. It cannot continue there, and it needs care quickly; the warning signs and the first steps are on our ectopic pregnancy page. This guide is about one of the operations used to treat it: laparoscopic salpingostomy, the tube-saving surgery for ectopic pregnancy. The video shows real operative footage of this operation, from 2019. This page is general information only; the right treatment for any woman is decided with her own doctor, from her own scan, her blood tests and how she is.

What happens in a laparoscopic salpingostomy?

In this video, our consultant shows a salpingostomy in which only the pregnancy tissue is taken out of the fallopian tube; the tube is washed out several times and then left to heal on its own.

In general, the steps are:

1. Under general anaesthesia, a telescope and fine instruments are passed through small cuts in the tummy. Read about anaesthesia for gynaecological surgery.
2. The surgeon finds the swollen part of the tube that holds the pregnancy, and checks the other tube, the womb and the ovaries.
3. A dilute medicine may be injected into the wall of the tube to reduce bleeding.
4. A small cut is made along the tube, over the pregnancy.
5. The pregnancy tissue is gently eased out, and the tube is rinsed with fluid to clear what remains.
6. Bleeding points are controlled, and the cut is usually left open to heal by itself rather than stitched.

The stay in hospital is usually short. What to expect in the days and weeks after the operation is on our page about keyhole surgery recovery.

Salpingostomy vs salpingectomy

There are two keyhole operations for a pregnancy in the tube:

• Salpingectomy removes the affected tube, with the pregnancy inside it.
• Salpingostomy opens the tube, removes the pregnancy and keeps the tube.

Keeping the tube sounds like the obvious choice, but it is not always the wiser one. When the other tube looks healthy, international guidelines generally favour salpingectomy: large studies found that the chance of a later natural pregnancy was broadly similar after either operation, while a salpingostomy carries a risk that some pregnancy tissue is left behind. A salpingostomy is considered more often when the other tube is missing or damaged, or when there are other reasons to protect fertility. The tube may still have to be removed if it has burst, if the bleeding is heavy, or if it is badly damaged.

Who is it suitable for?

The choice between watchful monitoring, a medicine called methotrexate and an operation depends on the hCG level, the size of the pregnancy on the scan, how well the woman is, and whether there is bleeding inside the tummy. A salpingostomy needs a woman who is stable, a tube that has not burst, and a plan for close follow-up. A woman who is bleeding heavily inside needs urgent surgery, and then the first aim is to stop the bleeding. How keyhole surgery works is explained on our laparoscopic surgery page.

After the operation: hCG follow-up

Because the tube is kept, a small amount of pregnancy tissue can remain and go on growing. This is called persistent trophoblast. For this reason, the pregnancy hormone, hCG, is checked with blood tests, usually once a week, until it falls to a non-pregnant level. If it stays up or rises, a methotrexate injection or a further operation may be needed. Please keep every blood-test appointment, and come back at once if the pain returns. Women whose blood group is Rh negative may need an anti-D injection after the operation.

Pregnancy after ectopic surgery

Many women go on to have a pregnancy in the womb after an ectopic pregnancy, whether the tube was kept or removed. The chance of another ectopic pregnancy is higher than for women who have never had one, and a tube that has been operated on can hold a further one. So in the next pregnancy, see a doctor early, by about six weeks, for a scan that confirms where the pregnancy is. Most doctors advise waiting until the hCG is back to normal and you feel recovered before trying again. If a pregnancy does not follow, the tubes can be checked with an HSG tube test, and IVF remains an option when both tubes are blocked or missing.

For doctors: technical notes

General principles from the published literature, not a description of the video:

• Select a haemodynamically stable patient with an unruptured tubal ectopic, and inspect the contralateral tube before deciding between salpingostomy and salpingectomy.
• Make a linear incision on the antimesenteric border over the point of maximal distension, after dilute vasopressin infiltration according to your local protocol.
• Express the products with hydrodissection and irrigation rather than by traction with forceps, which tends to bleed from the implantation site.
• Use bipolar energy sparingly on the mucosa, and leave the incision to heal by secondary intention.
• Document the site, the size and the state of the tube, and arrange serial hCG until it reaches a non-pregnant level.

About this guide

This guide is by the Pai Hospital Team. Pai Hospital is at Vaddem, Vasco-da-Gama, Goa, with its own operating theatre, and it is open 24 hours for pregnancy and gynaecology emergencies. The video is one of our consultant's teaching videos on YouTube; it shows one patient's operation, and every woman's case is different.

This article is for education only and is not personal medical advice; please speak to your own doctor about your situation.

Your questions

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This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.