Is Distal Partial Salpingectomy with an Endoloop Ligature Safe, Fast, and Effective for Nonisthmic Tubal Ectopic Pregnancy in Low-Socioeconomic-Status Countries?

Objective: Total salpingectomy is the "gold standard" treatment for tubal ectopic pregnancy. This procedure avoids the risks of persistent trophoblasts and recurrent ipsilateral tubal pregnancies but affects ovarian blood supply. Is distal partial salpingectomy, using an Endoloop (R) Ligature (made with polydioxanone II a, violet monofilament; Ethicon, Somerville, NJ) an easy and fast way to remove the tubal fimbria, without producing a thermal destructive effect? Is the procedure minimally associated with risks of persistent trophoblast and recurrent ipsilateral tubal pregnancies? Should distal partial salpingectomy be recommended for nonisthmic tubal pregnancy, especially in countries of low socioeconomic status? Materials and Methods: In this controlled, comparative observational trial, 54 women with ampullary or fimbrial tubal ectopic pregnancies underwent laparoscopic salpingectomy. The patients were divided into 2 groups of 27 patients each. Group 1 underwent distal partial salpingectomy, using an Endoloop Ligature and group 2 underwent the gold standard total salpingectomy, using bipolar diathermy. Primary outcomes were duration of operative procedure and intraoperative hemoglobin loss; secondary outcomes were recurrent ectopic pregnancy in the ipsilateral tube, persistent trophoblast tissues, and spontaneous intrauterine pregnancy later. Results: Use of an Endoloop Ligature was associated with significantly shorter operating times and less intraoperative hemoglobin loss. No cases of recurrent ectopic pregnancies in the ipsilateral tubes or persistent trophoblast tissues were reported in both studied groups. Seventeen (62.9%) and 16 (59.2%) women achieved spontaneous intrauterine pregnancies during the follow-up period in both groups, respectively. Conclusions: Performing distal partial salpingectomy using an Endoloop Ligature is a safe, rapid, and effective procedure, compared to electrosurgical total salpingectomy. Further studies are still needed to support distal partial salpingectomy as a recommended treatment.