Laparoscopic salpingostomy versus laparoscopic local methotrexate injection in the management of unruptured ectopic gestation

OBJECTIVE: Our goal was to determine whether laparoscopic salpingostomy is preferable to laparoscopic methotrexate injection in the management of unruptured tubal gestation. STUDY DESIGN: Forty-eight patients with unruptured tubal pregnancy were prospectively randomized to either laparoscopic salpingostomy or laparoscopic local methotrexate injection in a university medical center. Operation time, duration of hospital stay, decrease in levels of β-human chorionic gonadotropin, and fertility outcome were compared between the two groups. RESULTS: The salpingostomy group had a longer operative time (p < 0.0001) but a shorter hospital stay (p < 0.01) and a lower incidence of persistent trophoblastic activity (5% vs 14%), although this difference did not reach statistical significance. The time interval until β-human chorionic gonadotropin disappearance was similar (13.9 and 13.7 days), and the subsequent intrauterine pregnancy rate was similar in the two groups (83.5% and 81%). One repeat tubal pregnancy occurred in the salpingostomy group. CONCLUSIONS: Both these methods of conservative management are equally effective and each one has its merits. (Am J Obstet Gynecol 1996;175:600-2.)