J. Rehbock et al., DISSEMINATED PERITONEAL TROPHOBLASTIC IMP LANTS AFTER SURGERY OF TUBAL PREGNANCIES - A TYPICAL COMPLICATION OF THE LAPAROSCOPIC TECHNIQUE, Geburtshilfe und Frauenheilkunde, 57(3), 1997, pp. 155-157
Surgical techniques require continuous evaluation. At present, this is
especially true for laparoscopic oncologic procedures. On the other h
and, non-oncological surgical techniques also warrant critical re-asse
ssment. This is illustrated by the case report of a patient who receiv
ed conservative laparoscopic treatment of tubal pregnancy, presenting
with rising HCG concentrations in her serum two weeks after the initia
l surgery. A second laparoscopy revealed multiple disseminated periton
eal trophoblast tissue implants along the mesosalpinx and throughout t
he pelvis. Resection of the tissue implants was followed by a decline
of HCG below the detection limit. In the literature, disseminated trop
hoblast implants are described in up to 3.6% of cases following laparo
scopic treatment of tubal pregnancy, and hence, surprisingly enough, a
re not a rare event. It is suggested to take special care to remove al
l trophoblastic tissue from the peritoneal cavity during primary surge
ry when performing salpingotomy. During salpingectomy, fragmentation o
f the tube can be avoided by using an endobag procedure. In case of tr
ophoblast persistence, a second laparoscopy with meticulous inspection
of the abdomen and removal of any disseminated tissue is recommended.