DISSEMINATED PERITONEAL TROPHOBLASTIC IMP LANTS AFTER SURGERY OF TUBAL PREGNANCIES - A TYPICAL COMPLICATION OF THE LAPAROSCOPIC TECHNIQUE

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.