A 29-year-old woman presents with a ruptured left tubal ectopic pregnancy and hemoperitoneum. She undergoes emergency laparotomy. Which surgical procedure is most appropriate if the contralateral tube appears normal and she desires future fertility?

• A Milking of the tube (expression)
• B Linear salpingostomy
• C Segmental resection with delayed anastomosis
• D Total salpingectomy ✓

Explanation

Current evidence from the DEMETER and other trials shows that salpingectomy does not significantly reduce subsequent intrauterine pregnancy rates compared with salpingostomy, while salpingectomy eliminates the risk of persistent trophoblast and recurrent ectopic in the same tube. With a normal contralateral tube, salpingectomy is the standard of care. Milking carries a high persistent trophoblast rate and is no longer recommended.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.