salpingostomy

Salpingostomy is a surgical procedure that creates an opening in the wall of the fallopian tube to access its interior, most often to remove an ectopic pregnancy while preserving the tube. It is performed as an alternative to salpingectomy, which removes the tube entirely.

Indications for salpingostomy include hemodynamically stable patients with a tubal ectopic pregnancy when preservation of tubal function is desired to maintain future fertility. It is not appropriate in cases of rupture with active heavy bleeding or when the tube is severely damaged.

Technique and course: The procedure is usually performed laparoscopically. An incision is made on the antimesenteric border of the affected tube over the ectopic gestation. The products of conception are carefully evacuated, and the site is checked for hemostasis. The tubal incision is generally left open to heal by secondary intention rather than suturing the edges closed, although some surgeons may place fine sutures to control bleeding or to optimize tubal anatomy in selected cases.

Outcomes and risks: Salpingostomy can preserve tubal tissue and potential fertility but carries risks of persistent ectopic tissue requiring additional treatment (including methotrexate or repeat surgery) and a continued risk of another ectopic pregnancy. Tubal patency after salpingostomy varies, and prior tubal disease and ectopic location influence reproductive outcomes. Other risks include bleeding, infection, and injury to surrounding structures.

See also: Alternatives in ectopic pregnancy management include salpingectomy and medical management with methotrexate.