Table 1.
Comparison of fertility outcomes of salpingotomy versus salpingectomy from non-randomised studies and meta-analyses of observational studies (see text).
| Salpingotomy compared with salpingectomy as the reference treatment | ||||
| Ref | Primary treatment success | Sample size (sum of salpingectomy and salpingotomy cases unless otherwise stated) | Crude spontaneous intrauterine pregnancy (IUP) rates and/or fecundity rate ratios* (FRR) (95% CI) | Crude repeat ectopic pregnancy (REP) rates and/or fecundity rate ratios* (FRR) (95% CI) |
| Non-systematic review | Failure or rate of persistent ectopic pregnancy range 3–20% in 10 cohort studies comparing laparotomy with laparoscopic salpingotomy (corresponding results for salpingectomy not reported) | 1774 women (in 9 cohort studies) undergoing salpingotomy or salpingectomy for ectopic pregnancy, and desiring subsequent pregnancy | 280/528 (53%) with salpingotomy v 614/1246 (49%) with salpingectomy at 3 months–15 years: crude FRR 1.08 (0.97 to 1.19)* | 78/528 (15%) with salpingotomy v 123/1246 (10%) with salpingectomy at 3 months–15 years: crude FRR 1.50 (1.15 to 1.95)* |
| 176 women (in 18 cohort studies) with cTD after salpingotomy (corresponding results for salpingectomy not reported) | Salpingotomy in women with cTD then IUP in 96/176 (55%) | Salpingotomy in women with cTD then REP in 36/176 (21%) | ||
| Prospective cohort | 8/86 (9%) of women having either subsequent laparoscopic salpingectomy or methotrexate because of treatment failure of salpingotomy. Treatment failures due to salpingectomy not reported | 86 women undergoing laparoscopic surgery for ectopic pregnancy and attempting conception | 36/60 (60%) with salpingotomy v 14/26 (54%) with salpingectomy at 48 months: FRR 1.11 (0.77 to 1.76)* | 11/60 (18%) with salpingotomy v 2/26 (8%) with salpingectomy at 48 months: FRR 2.38 (0.67 to 9.30)* |
| cTD present in 33/60 (55%) of women who had salpingotomy and 15/26 (58%) of women who had salpingectomy | Irrespective of the type of surgery performed and if cTD: crude FRR (women with cTD v no cTD) 0.53 (0.36 to 0.75)* (based on 20/50 [40%] pregnant with cTD v 27/34 [79%] not pregnant with cTD; type of surgery not reported) | |||
| Retrospective cohort | Not reported | 135 women undergoing laparoscopy or laparotomy for ectopic pregnancy | 62% with salpingotomy v 38% with salpingectomy at 3 years (numbers not reported). FRR (at 18 months) 1.9 (0.91 to 3.8) | 28% with salpingotomy v 23% with salpingectomy at 3 years (numbers not reported): FRR 2.4 (0.57 to 11) |
| cTD present in 15/56 (27%) of women having salpingotomy and 38/79 (48%) having salpingectomy | In women with cTD: 2/6 (33%) with salpingotomy v 3/8 (38%) with salpingectomy; FRR 0.80 (0.13 to 4.9) In women with bilateral tubal pathology: 1/8 (13%) with salpingotomy v 3/25 (12%) with salpingectomy; FRR 1.4 (0.13 to 16) | Irrespective of the type of surgery performed and if cTD: FRR 0.79 (0.18 to 3.4) (numbers and which type of surgery the women had not reported) | ||
| Retrospective cohort | Not reported | 276 women undergoing salpingotomy or salpingectomy for first ectopic pregnancy | 89% with salpingotomy v 66% with salpingectomy at 7 years (numbers not reported): FRR 1.58 (1.06 to 2.38)* | 17% with salpingotomy v 16% with salpingectomy at 2 years (numbers not reported): FRR 1.28 (0.57 to 2.87)* |
| cTD present in 30/208 (14%) of women with salpingotomy and 17/68 (25%) with salpingectomy | Irrespective of the type of surgery performed: FRR (women with cTD v no cTD) 0.46 (0.26 to 0.82)* (numbers and type of surgery not reported) | Irrespective of the type of surgery performed: FRR (women with cTD v no cTD) 2.25 (1.11 to 4.531)* (numbers and type of surgery not reported) | ||
| Cohort | Initial treatment failure: 1/178 [1%] with salpingectomy v 14/262 [5%] with salpingotomy v 13/36 [36%] with methotrexate | 476 women with tubal ectopic pregnancy who were not using contraception at conceptionSalpingotomy in 262 women: cTD in 236/262 (90%). Salpingectomy in 178 women, cTD in 159/178 (89%). Methotrexate in 36 women: cTD in 8/36 (22%). | 73% with salpingotomy v 57% with salpingectomy v 80% with methotrexate Irrespective of the type of surgery performed and if cTD: FRR (women with cTD v no cTD) 0.53 (0.33 to 0.83)* In women with infertility factors: salpingotomy v salpingectomy FRR 1.67 (1 to 2.78);* methotrexate v salpingectomy FRR 2.5 (1.95 to 8.33)* In women with no infertility factors: salpingotomy v salpingectomy FRR 1.18 (0.63 to 2.22);* methotrexate v salpingectomy FRR 2.12 (0.49 to 9.78)* (numbers not reported) | 25% with salpingotomy v 27% with salpingectomy v 41% with methotrexate Salpingotomy v salpingectomy: FRR 0.93 (0.76 to 3.5)* Methotrexate v salpingectomy: FRR 1.51 (0.25 to 7.08)* (numbers not reported) |
| 1595 women with ectopic pregnancySalpingotomy in 798 (50%); salpingectomy in 654 (41%); methotrexate in 143 (9%)Number of women with cTD for each treatment not stated | Salpingotomy v salpingectomy: FRR 1.25 (1 to 1.67)* Methotrexate v salpingectomy: FRR 1.25 (0.7 to 2.33)* Irrespective of the type of surgery performed and if cTD: FRR (women with cTD v no cTD) 0.83 (0.67 to 1.0)* (numbers not reported) | Salpingotomy v salpingectomy: FRR 1.25 (0.67 to 2)* Methotrexate v salpingectomy: FRR 2.25 (0.6 to 7.4)* If irrespective of the type of surgery performed and if cTD: FRR (women with cTD v no cTD) 1 (0.5 to 2.0)* (numbers not reported) |
cTD: contralateral tubal disease. This may be absent, occluded, or distorted by pathology (hydrosalpinges, adhesions). * FRRs: calculated by Clinical Evidence contributor. FRRs are stated for salpingotomy compared with salpingectomy as the reference, unless otherwise stated. FRRs are also stated for the presence relative to absence of confounding factors (e.g. cTD or infertility), disregarding the type of surgery (either salpingotomy or salpingectomy) that was performed. Where studies have calculated FRR using salpingotomy as the reference standard, the reciprocal of this FRR has been quoted, because this provides the FRR of salpingotomy compared with salpingectomy as the reference standard. Crude FRRs: We report an FRR based on the results reported in the meta-analysis. However, due to study heterogeneity and non-adoption of survival analysis techniques by included studies within the meta-analysis, a pooled FRR (as we have reported) is likely to be crude and subject to bias.