Evaluation of the transvaginal resection of low segment cesarean scar ectopic pregnancies

Capsule:
This article discusses the advantages of the transvaginal approach for exogenous CSEP lesion resection and introduces the surgical procedure in detail.

Authors:
Dan-Bo Wang, Ph.D., Ying-Han Chen, Zhi-Fang Zhang, Peng Chen, Kui-Ran Liu, Yan Li, Li Fu

Volume 101, Issue 2, Pages 602-606, February 2014

Abstract:

Objective:
To evaluate the transvaginal approach for exogenous cesarean scar ectopic pregnancy (CSEP) lesion resection, according to our experience.

Design:
Retrospective study.

Setting:
University hospital.

Patient(s):
Twenty-three patients with confirmed exogenous CSEP treated with transvaginal resection of the lesions at the Shengjing Hospital of China Medical University.

Intervention(s):
Lesion resection by the transvaginal approach.

Main Outcome Measure(s):
Surgery time, intraoperative blood loss, postoperative drainage volume, and average days of postoperative hospitalization were compared between the transvaginal procedure group and the transabdominal procedure group.

Result(s):
Significant differences were found. No significant differences were found in the drop of serum hCG level after 48 hours and the postoperative recurrence rate between the two groups. The rate of successful treatment was 96%.

Conclusion(s):
The transvaginal approach for exogenous CSEP lesion resection possesses many advantages. In the hands of a skilled surgeon it can readily address the treatment problems posed by an exogenous CSEP without imposing an increase in surgical risk or technical difficulty.

  • Amanda N. Kallen

    Thank you to the authors for this interesting paper – scar ectopic certainly presents a clinical dilemma and I read the details of the transvaginal approach with great interest. I have two questions for the authors. First, it’s mentioned that two patients achieved intrauterine pregnancy after transvaginal scar resection. Do you have outcome data on those pregnancies? And second, how does the success rate of transvaginal approach compare with the published success rate of the laparoscopic approach? The authors rightly point out that skill in transvaginal surgery is a gynecologic “staple”, but I would argue that many gynecologic surgeons are graduating with more experience in laparoscopic surgery these days…!

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