**5. References**

92 Ectopic Pregnancy – Modern Diagnosis and Management

Fig. 3. (a) hydrosalpinges and peritubal adhesions; (b) salpingotomy on both sides and

Case series and cohort studies demonstrated high pregnancy rates following microsurgical tubo-cornual anastomosis (Johnson et al., 2010). A review of eleven case series in women who underwent proximal tubal operations by microsurgery (n = 490) reported a cumulative EP rate of 0% to 12% and a rate of IUP of 22% to 74% concerning to all patients (Posaci et al., 1999). The largest study from 1997 showed an EP rate of 11% and an IUP rate of 74% after a three year follow-up (Dubiusson et al., 1997). Negativ prognostic factors on the pregnancy rate after tubocornual anastomosis are reduced residual length, damaged intramural portion, presence of chronical inflammation and tubal inclusion in the tubal wall, and tubal

In our own study with 68 patients, the EP rate was 10.3% (7/68 patients) whereas the IUP rate was 55.9% (38/68 patients) when tubal anastomosis (reversal of sterilization excluded)

In cases of tubal infertility, it is today possible to fulfill a couple's desire to have a child either by means of a reconstructive operation of the fallopian tubes or by IVF therapy. The success of treatment - even when attempted multiple times - cannot be guaranteed. In

adhesiolysis

Fig. 4. (a) fimbrial phimosis; (b) fimbrioplasty

endometriosis (Posaci et al., 1999).

was performed (Table 2).

**3. Conclusion** 

**2.2.3 Proximal tubal disease: tubo-cornual anastomosis** 


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**6** 

*Japan* 

**Persistent Ectopic Pregnancy After** 

Shigeo Akira, Takashi Abe and Toshiyuki Takeshita

**Laparoscopic Linear Salpingostomy for Tubal** 

Persistent ectopic pregnancy (PEP) is a condition that occurs due to incomplete removal of trophoblastic tissue during fallopian tube-preservation surgery for tubal pregnancy. According to several studies, the incidence has been reported to be approximately 3%-20%,1 and the incidence appears to be rising due to the increase in treatment of tubal pregnancies via laparoscopic surgery.2-4 If treatment for PEP is delayed, tubal rupture and intraabdominal hemorrhage can occur and may be accompanied by significant morbidity and

Methotrexate (MTX), a cytostatic agent with proven anti-trophoblastic activity, has been used for the treatment of ectopic pregnancies, and has also been reported to be useful for treating PEPs.5-6 Therefore, combined use of MTX following conservative tubal surgery may

Indeed, MTX has thus far been reported to significantly decrease the occurrence of PEP when systemically-administered in a single dose within 24 hours after laparoscopic linear salpingostomy.7 However, systemic MTX administration has been reported to cause side effects and must be used with caution.8,9 In contrast, local MTX administration into the tube, either laparoscopically10,11 or through transvaginal ultrasonography12,13, has been associated with few side effects, and may be useful as a prophylactic for PEP. Therefore, local MTX administration after linear salpingostomy could prevent PEP without serious side effects. In this chapter, we examined the efficacy of local MTX administration after linear salpingostomy for tubal pregnancies in preventing PEP, and evaluated the usefulness of postoperative serum human chorionic gonadotropin (hCG) decline (percentage of the

Patients who underwent linear salpingostomies between January 1996 and December 2010 were enrolled in the study. A linear salpingostomy was indicated according to the following criteria: 1) stable circulatory dynamics; 2) desired future pregnancy; 3) no tubal rupture; 4) absence of marked tubal adhesions; 5) ectopic pregnancy diameter < 5 cm; 6) absence of a

mortality. Therefore, prevention and early detection of PEP is of great importance.

preoperative hCG level) for early detection and ruling out of PEP.

**1. Introduction** 

facilitate prevention of PEP.

**2. Subjects and methods** 

**2.1 Patients selection** 

**Pregnancy: Prevention and Early Detection** 

*Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo,* 

