The outcomes of pregnancies after laparoscopic surgeries for pathologic changes on distal oviduct:A systematic review and meta-analysis

Objective This systematic review and meta-analysis were aimed to summarize the body of evidence on the prognosis after laparoscopic surgeries for pathological conditions on distal oviducts,then,furthermore,to evaluate prognostic factors for pregnancy outcomes.Methods We conducted a systematic review and meta-analysis to summarize the body of evidence on this topic,with the review question formulated as“what is the prognosis after the laparoscopic fimbrioplasty,salpingostomy,or salpingoneostomy for patients with pathologic conditions on the distal oviducts.”We searched Medline and EMBASE on June 1st,2020.Two investigators(HH and ZY)independently screened the references of all retrieved records for potentially eligible studies by firstly,through titles and abstract,and then full-text.A study would be included if it was a primary study reporting pregnancy outcomes of patients after laparascopic surgery.A meta-analysis of the rates of pregnancy,ectopic pregnancy,live birth,and miscarriage was performed using a random effect model.Results We identified 3861 records and included 21 reports with 2473 participants.The pooled estimate for the pregnancy rate was 35.1%(95%CI:30.7%–39.7%,I^(2)=78%,low certainty).The pooled estimates for the live birth rate,ectopic pregnancy rate,and miscarriage were 24.4%(95%CI:20.2%–28.8%,I^(2)=58%;1154 participants;low certainty),6.2%(95%CI:4.4%–8.2%,I^(2)=61%;2363 participants;low certainty),and 4.6%(95%CI:2.8%–6.9%,I^(2)=10%;544 participants;low certainty).Our analyses suggested that the more damaged tubal was associated with a decreased pregnancy rate,and patients with moderate or severe adhesion had lower pregnancy rates compared with patients with mild pelvic adhesion.Conclusion We estimated the pregnancy rate,ectopic pregnancy rate,and miscarriage rate of patients with distal tubal pathology after the laparoscopic fimbrioplasty or salpingostomy.Low certainty evidence suggested that laparoscopic surgery can restore the tubal function and cure infertility and should be considered as an alternative to in vitro fertilization.Tubal damage stage and adhesion are associated with worse pregnancy outcomes.

Laparoscopic management of recurrent ectopic pregnancy: A retrospective cohort study describing 10-years of experience in a tertiary care hospital

Objective:Recurrent ectopic pregnancy(REP)is rare,but can have severe consequences for patients.The aim of this study was to report outcomes of laparoscopic management of REP in our center.Methods:Retrospective cohort study including REP treated surgically at a single,tertiary-care academic medical center between 2009 and 2018.All patients undergoing laparoscopic salpingostomy or salpingectomy were included.Patients were then followed up to monitor outcomes of future reproductive events.Results:Of 41 eligible patients,14 suffered from ipsilateral recurrence including 5 cases of tubal stump pregnancy.In the other 27 cases,the REP occurred in the contralateral tube that was previously unaffected.All patients with ipsilateral recurrence underwent salpingectomy.In patients with contralateral recurrence,salpingectomy was carried out in 21 patients(77.8%)and salpingostomy in 6 patients(22.2%).32 patients(78%)subsequently sought to conceive either spontaneously or by in vitro fertilization.The subsequent live birth rates were 51.8%(14/27)in the salpingectomy group and 60.0%(3/5)in the salpingostomy group.Conclusion:Where trained laparoscopists and adequate facilities are available,it is possible to achieve acceptable reproductive outcomes after REP irrespective of the surgical approach.