Laparoscopy or laparotomy for high-risk caesarean scar pregnancy: a
retrospective study
Abstract
Objective The aim of this study was to compare the outcomes of
laparotomy and laparoscopy in the treatment of high-risk caesarean scar
pregnancy (CSP) and evaluate the optimal treatment measure. Design A
retrospective study. Setting Tongji Hospital. Population Two hundred
seventy-eight patients with CSP between 2013 and 2018. Methods We
compared and analysed the characteristics of laparoscopic and open
surgery in the treatment of high-risk CSP and the advantages and
disadvantages of different methods of vascular pretreatment. We also
systematically evaluated CSP patients undergoing laparoscopic or
laparotomic surgery. Results The intraoperative bleeding volume,
transfusion rate, and total number of days of hospitalization and
postoperative hospitalization were better in the laparoscopy group than
in the laparotomy group (p<0.05). There were no differences in
factors (β-hCG decrease, reoperation and residual tissue) closely
related to surgical success between the two groups. Furthermore, we
pretreated blood vessels differently before the operation. The residual
tissue, reoperation and intraoperative blood transfusion rates in
patients treated with temporary vascular occlusion were better than
those in patients treated with permanent vascular occlusion. A
systematic review of English literature showed that most of the current
studies on CSP are case reports and retrospective analyses (67.74% and
29.03%, respectively), and the sample sizes of these studies are very
small. Conclusions This study reveals that laparoscopic surgery is
superior to laparotomic surgery in the treatment of high-risk CSP.
Patients benefitted from temporary arterial occlusion in both groups.
Temporary arterial occlusion with laparoscopic surgery may be the best
treatment for high-risk CSP.