Introduction
Interstitial pregnancy is a type of ectopic pregnancy which occurs in the uterus but outside the uterine cavity, implantation occurs in the interstitial (proximal) part of the fallopian tube at its insertion into the uterus (1–3). It’s a life-threatening rare condition with an incidence of about 1-4% of all types of tubal ectopic pregnancies and approximately one time every 2500-5000 live births (4). Many risk factors may predispose to interstitial pregnancy including pelvic surgery and inflammatory diseases, tumors, anomalies of the uterus, and in-vitro fertilization (5). Many cases can be asymptomatic or present with non-specific symptoms such as vaginal bleeding and abdominal pain therefore, the diagnosis is often delayed which increases the risk of rupture (5–7). Diagnosis depends on high levels of suspicion, especially in women who have any risk factor. Interstitial and cornual pregnancy may be used as synonyms of each other as reported in some studies However, they are actually two different conditions as cornual pregnancy occurs mainly in the horn of a bicornuate uterus (6–8).
Many modalities were used for management including medical treatment such as local and systemic methotrexate, expectant, open, and minimally invasive surgical techniques (1). Choosing a treatment option is depending on some criteria like the patient’s desire for future fertility and whether the rupture has occurred or not. Medical or expectant treatment are used only in asymptomatic and hemodynamically stable patient cases (1). Surgical management is the main line of management in most cases especially in ruptured ones. These surgical options are either laparoscopy or laparotomy depending on the patient’s condition and available resources. Traditionally, open surgery as laparotomy with cornual resection or hysterectomy was used but with the progression in surgical approaches, laparoscopic surgeries have shown better results compared with laparotomy (9). Laparoscopic surgery for ectopic pregnancies is done through different approaches as cornuostomy, salpingostomy, cornual resection, and mini-cornual excision (10–14). Laparoscopic surgery may have advantages over laparotomy such as lower hospital stay duration, less postoperative pain, lower blood loss, and skin incision (15,16).
Some reports have reviewed most of the treatment modalities and described a road map for the management of ectopic pregnancies but these reports include few or no interstitial pregnancy cases (1,17) and no clear evidence for selecting the most suitable surgical approach in interstitial pregnancy. Therefore, we aim to compare laparotomy with laparoscopic management of interstitial pregnancy as evidenced from published studies.