[Surgical treatment of extrauterine pregnancy: end of the era of laparotomy?].

Ectopic pregnancies can now be recognized very early, and in most cases, before the appearance of dramatic symptoms. This can be attributed mainly to improved diagnostic methods, such as endovaginal sonography and serial determinations of human, chorionic gonadotropin and progesterone. For this reason, extrauterine pregnancies can currently be treated by several methods, and emergency laparotomy is seldom indicated. Advances in treatment modalities, including tubal-conserving operations, laparoscopic approaches, medical treatment with methotrexate, and expectant management have all been proved to be safe and effective. Between January 1994 and June 1995, 166 patients were treated surgically for extrauterine pregnancy. Of these, 94.6% were treated by laparoscopy; laparotomy was required in only 9 (5.4%). Fecundity rates after laparoscopic treatment for ectopic pregnancy are comparable, if not better, than in those treated by laparotomy. Laparoscopic surgery offers advantages, such as reduction in operating time and shorter hospital stay and convalescence, as compared to conventional abdominal surgery. To date, surgical removal of an ectopic pregnancy remains the method of choice and this can be performed safely by laparoscopy.