Discussion
We found that laparoscopic surgery was significantly associated with less postoperative hospital stay period and less operation time than open surgery. However, we found no difference between both types in terms of blood loss, post and intraoperative complications, and need for blood transfusion.
Our results were consistent with other studies published in the literature. Laparoscopic surgery has many advantages such as minimal skin incision and a little hospital stay period, preserve the uterus for future fertility, improved and fast recovery and less postoperative pain (7,9), but also it has some minor disadvantages like hematomas of the abdominal wall occurring near the incisions, some abdominal or pelvic infections but Serious laparoscopy complications are rare (25).
Laparotomy is the second line of management when there is no laparoscopic expertise or when adequate closure or hemostasis cannot be achieved by laparoscopic surgery. However, it has a lot of risks ranging from the general risks of anesthesia and surgery to incisional hernia, infections, bleeding, and injury of pelvic or abdominal organs. Also, it is accompanied by longer hospital stay periods as reported in some studies (26,27).
Two previous systematic reviews have described a road map for nearly all medical and surgical options and they recommended using laparoscopic surgery in most conditions (1,17).
A previous meta-analysis compared between laparoscopy and laparotomy for ectopic pregnancy and concluded that laparoscopy is better than laparotomy. However, contrary to our results, they found no difference between laparoscopy and laparotomy in terms of operation time which we found was lower in the laparoscopic group. Additionally, they found that intraoperative blood loss was lower in the laparoscopy arm compared with laparotomy (28).
Some studies compared different laparoscopic approaches, the study by Lee et. al 2016 (29) compared laparoscopic cornual resection and laparoscopic cornuotomy and found no significant difference between them in hemoglobin levels after the operation and persistent interstitial pregnancy and incidence of major complications but the operation time was significantly shorter for cornuotomy than that for cornual resection. Also, Gasparria et. al 2018 (30) compared conventional versus single port laparoscopy and found no difference between them in hemoglobin levels, need for blood transfusions, operation time, length of hospital stay period, and post- and intra-operative complications.
In a cost-effectiveness comparison between laparoscopic and laparotomy, Gray et. al 1995 (31) showed that at lower costs, laparoscopy produced final outcomes comparable to those of laparotomy. Also Ghazali et. al 2018 (27) stated that laparoscopy was associated with financial savings.
We included all studies comparing laparoscopic surgery with laparotomy in interstitial ectopic pregnancy patients. Additionally, most of our results were homogenous and we managed to solve the heterogeneity detected among studies.
However, we have some limitations in our study such as: 1- Small number of the included studies and small sample size. 2- The lack of data about long term effect. 3- All of the included studies were observational which are considered at low level of evidence.