Comparison of the Fertility Outcome of Salpingotomy and Salpingectomy in Women with Tubal Pregnancy: A Systematic Review and Meta-Analysis.

Authors:
Xiaolin Cheng
Xiaolin Cheng
Howard Hughes Medical Institute
United States
Xiaoyu Tian
Xiaoyu Tian
Northeastern University
United States
Zhen Yan
Zhen Yan
State University of New York at Buffalo
Buffalo | United States
Mengmeng Jia
Mengmeng Jia
College of Materials
Oxford | United Kingdom
Jie Deng
Jie Deng
Laboratory of Virology
Fairbanks | United States
Ying Wang
Ying Wang
CAS Key Laboratory of Functional Materials and Devices for Special Environments
Hong Kong
Dongmei Fan
Dongmei Fan
Chinese Academy of Medical Sciences & Peking Union Medical College
China

PLoS One 2016 25;11(3):e0152343. Epub 2016 Mar 25.

Department of Obstetrics and Gynecology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan Province, China.

Objective: To compare the natural fertility outcomes of salpingotomy and salpingectomy among women treated for tubal pregnancy.

Methods: An online database search including PubMed, Embase, CENTRAL and Web of Science was performed to identify studies comparing salpingotomy and salpingectomy to treat women with tubal pregnancy. The search included papers published after the databases were established until May 2015. Two reviewers independently screened literature according to the inclusion and exclusion criteria and then extracted data and assessed the methodological quality of all of the included studies. The meta-analysis was conducted using RevMan 5.3 software. The registration number is CRD42015017545 in PROSPERO.

Results: Two randomized controlled trials (RCTs) and eight cohort studies, including a total of 1,229 patients, were znalyzed. The meta-analysis of the RCT subgroup indicated that there was no statistically significant difference in IUP rates (RR = 1.04, 95% CI = 0.89-1.21, P = 0.61) nor the repeat ectopic pregnancy (REP) rate (RR = 1.30, 95% CI = 0.72-2.38, P = 0.39) between the salpingotomy and salpingectomy group. In contrast, the cohort study subgroup analysis revealed that the IUP rate was higher in the salpingotomy group compared with the salpingectomy group (RR = 1.24, 95% CI = 1.08-1.42, P = 0.002); Salpingotomy also increased the risk of REP rate (RR = 2.27, 95% CI = 1.12-4.58, P = 0.02). The persistent ectopic pregnancy (PEP) occurred more frequently in the salpingotomy group than the salpingectomy group (RR = 11.61, 95% CI = 3.17-42.46, P = 0.0002). An IUP would be more likely to occur after salpingotomy than salpingectomy when the follow-up time was more than 36 months (RR = 1.16, 95% CI = 1.02-1.32, P = 0.03). The IUP rate (RR = 1.13, 95% CI = 1.01-1.26, P = 0.03), and the REP rate (RR = 1.62, 95% CI = 1.02-2.56, P = 0.04) was higher after salpingotomy than salpingectomy among patients from Europe compared with those from America.

Conclusions: Based on the available evidence, we believe that for patients with a healthy contralateral tube operated for tubal pregnancy, the subsequent fertility after salpingectomy and salpingotomy are similar in the long term. The fertility prospects will not be improved via salpingotomy compared with salpingectomy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152343PLOSFound
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807767PMCFound
August 2016
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