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.