PREOPERATIVE SERUM HCG LEVEL AND INTRAOPERATIVE FAILURE OF LAPAROSCOPIC LINEAR SALPINGOSTOMY FOR ECTOPIC PREGNANCY

Objective: To identify factors that predict failure of linear salpingo stomy requiring salpingectomy for ectopic pregnancy. Methods: Using a retrospective cohort, we examined the various risk factors of women wi th ectopic pregnancies presenting for conservative laparoscopic manage ment. Success or failure of laparoscopic linear salpingostomy was the primary end point. Results: One hundred fifty-seven women underwent la paroscopic linear salpingostomy for ectopic pregnancy, of whom 120 had successful procedures and 36 had unsuccessful operations because of b leeding and needed subsequent salpingectomy either by laparoscopy or l aparotomy. The likelihood of success of laparoscopic linear salpingost omy was unrelated to gestational age, size of the ectopic pregnancy, s urgical technique, or experience of the surgeon or resident. However, median (quartiles) serum beta hCG levels were significantly higher in patients who underwent failed salpingostomy (10,103 [3549-19,962] IU/L ) compared with those who underwent successful salpingostomy (1692 [56 5-3971] IU/L, P < .01). Median blood loss (225 [181-562] mL versus 100 [50-200] mL, respectively, P < .01) and mean (a standard error of the mean [SEM]) operating times (111.1 +/- 6.1 minutes versus 76.8 +/- 2. 3 minutes, P < .01) were significantly greater with failed salpingosto my followed by salpingectomy, compared with successful salpingostomy. Conclusion: Preoperative serum beta hCG level was the only significant determinant of failure of laparoscopic linear salpingostomy for ectop ic pregnancy. Morbidity due to intraoperative blood loss and operating time was significantly increased as a result of attempting and failin g to complete laparoscopic linear salpingostomy. (Obstet Gynecol 1998; 92:373-6. (C) 1998 by The American College of Obstetricians and Gyneco logists.).