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.