All materials on the site were prepared by specialists in the field of surgery, anatomy and related disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Operation for ectopic pregnancy is carried out quite often due to the sufficient prevalence of the pathology. It can be planned or emergency, performed openly or laparoscopically.

During an ectopic pregnancy, the fertilized egg is fixed not in the uterus, but in other organs - the fallopian tube, ovary and even the peritoneum. This position of the fetus is not only incompatible with the normal development of pregnancy, but also poses a serious danger to the health or even the life of the patient.

Among the types of ectopic pregnancy there are tubal, ovarian, peritoneal, intraligamentary (between the leaves of the broad ligament of the uterus). More than 90% of pathology cases occur in tubal localization, when a fertilized egg cannot leave the tube for implantation into the endometrium, it begins to grow and is fixed to its wall by chorionic villi.

If at the time of implantation the endometrium has already created the maximum comfortable conditions for the embryo, then this cannot happen in the fallopian tube by definition - the organ plays a “transit” function, delivering the egg in the direction of the uterus.

The absence of a “cushion” in the form of the endometrium and the limited space of the tube lumen create high risk dangerous complications. The point is not only that the growth and development of the fetus is impossible outside the uterus, although occasional cases of peritoneal pregnancy have been described. The main danger of ectopic pregnancy in the tube is the possibility of organ rupture and massive bleeding, which can cost life.

Considering the futility of preserving the fertilized egg, the impossibility of its movement into the uterus after implantation outside the endometrium and the high risk of bleeding, surgery becomes the only option for treating the pathology.

Ectopic pregnancy on early stages has a number indirect signs, but if a woman comes for an ultrasound within the first month, the doctor will be able to make an accurate diagnosis. The absence of a fertilized egg in the endometrium is the main diagnostic criterion for pathology. Pregnancy in the tube develops over approximately 4-5 weeks, after which organ rupture is likely.

If during an ectopic pregnancy there has not yet been a violation of the integrity of the tube wall, then a planned operation is indicated. In the case when the pathology is diagnosed at the time of rupture of the tube and its artery (this does not happen rarely), emergency removal of the ectopic pregnancy is necessary to stop the bleeding.

Types of surgeries for ectopic pregnancy

The nature of the operation, duration, and access features are determined by the general condition of the patient, the course of the underlying pathology, and the technical capabilities for using any of the surgical methods.

Today, the main methods of removing a tube during an ectopic pregnancy are abdominal surgery and laparoscopy. The latter has a number of advantages, but is not always feasible due to the characteristics of the pathology.

Open tubectomy

Although doctors try to give preference to minimally invasive manipulations on internal organs, Abdominal surgery is still used in cases where other methods are impossible or impractical. Indications for tubectomy are:

• A woman’s reluctance to have children in the future;
• Severe adhesive disease and significant changes in the structure of the pipe;
• Plastic surgery in the past for tubal obstruction and infertility;
• Repeated pregnancy in the tube, which has previously been subjected to gentle treatment.

The Pfannenstiel surgical approach is optimal; it involves a transverse incision in the suprapubic region. Since the muscles of the abdominal wall do not intersect in the transverse direction, the healing of the defect occurs faster, and the cosmetic effect is quite good.

On the other hand, a transverse incision may not be enough for a good view of the pelvic cavity, the surgeon may not have sufficient skill, the operation may be emergency, requiring quick action, That's why median laparotomy, when the incision goes from top to bottom, is also used.

Abdominal surgery for tubal pregnancy is performed under general anesthesia. If 15-20 minutes are enough for manipulation, it can be performed without tracheal intubation. In cases where a longer intervention is planned, and the surgeon needs a wider “field of activity,” the anesthesiologist performs intubation and muscle relaxants are administered. The duration of the operation depends on a number of factors - the characteristics of the pathology, the presence or absence of a pipe rupture, general condition patients and averages half an hour or more.

During planned treatment, the patient undergoes the required minimum of examinations, including general blood and urine tests, ultrasound of the pelvic organs, coagulogram, fluorography, determination hCG level. Emergency intervention does not provide the opportunity for a full examination, therefore, at the preparation stage, blood tests are taken to determine its group, Rh factor, and clotting ability.

tubectomy

Stages of cavity removal of a “pregnant” tube (tubectomy):

1. An incision in the abdominal wall, manual inspection of the pelvic cavity, removal of the uterus and appendages into the wound;
2. In case of bleeding - urgent stop using a clamp;
3. Applying clamps to the mesentery of the tube and its segment facing the uterus, crossing it, ligating the vessels and crossing the peritoneum;
4. Removal of the organ, suturing of the peritoneum;
5. Inspection of the abdominal cavity, removal of blood clots, lavage, suturing tightly.

Organ-preserving operations

Numerous observations and experience of gynecological specialists prove that in most cases of ectopic pregnancy it is possible to perform organ-preserving interventions. The main goal of this treatment is to restore reproductive function by plastic surgery of the affected tube.

For best results, a tubal pregnancy should be detected as early as possible. To perform plastic surgery on a tube, certain conditions must be met:

• The fertilized egg should not be more than 4 cm;
• The fallopian tube should be intact, without rupture;
• Possibility of dynamic monitoring of hCG levels after intervention.

Young women without children, patients with a single tube or infertility are especially in need of an organ-conserving approach in the event of a tubal pregnancy.

If an ectopic pregnancy is detected early, and the integrity of the organ is not compromised, then during a planned operation, resection can be performed, that is, part of the tube is removed. To do this, after removing the uterus into the wound, clamps are applied to the tube, dissected longitudinally at the site of attachment of the embryo, it or a fragment of the tube in the area of ​​its ingrowth is removed, and then the ends are compared end-to-end. The wound is sutured, covered with peritoneum, the integrity of the abdominal wall is restored, after checking hemostasis.

To maintain patency of the affected tube, it is necessary to remove all fetal tissue, ligate the vessels, and act as carefully as possible in the surgical field, avoiding mechanical damage to the tissue.

Laparoscopic treatment of tubal pregnancy

Laparoscopy allows, with a minimum of surgical trauma, to remove the ectopic embryo, part or all of the tube, and stop bleeding. This method has a number of advantages compared to traditional open surgery, but an obstacle to its use may be the insufficient qualifications of the surgeon and the lack of appropriate equipment.

Laparoscopic treatment of ectopic pregnancy has virtually no contraindications. The only case when it is absolutely contraindicated is considered to be severe post-hemorrhagic shock with unstable hemodynamics. Among the relative contraindications, when the question of the method of operation is decided individually, are excess weight, pathology of the heart and lungs, and severe adhesive disease. A serious condition and the need for quick action in case of initial shock (blood loss of more than half a liter) or a ruptured tube can also become an obstacle to laparoscopy.

Modern equipment for laparoscopy allows for both radical treatment with removal of the entire tube, and gentle treatment with preservation of the organ and reproductive function.

During laparoscopic procedures, carbon dioxide is injected into the abdominal cavity, thereby providing a view of the internal organs, so such operations usually require the use of muscle relaxants and tracheal intubation. Instruments enter the abdominal cavity through three small punctures. If blood is found there, it should be removed immediately so that the clots do not impede the examination of the pelvic organs.

laparoscopic surgery

Tubectomy during laparoscopy is performed using the ligature method, when a loop is “thrown” onto the tube, which is tightened, and the tube with the embryo is cut off, and with an electrocoagulator. The coagulator heats up and, as it were, “seals” tissues and blood vessels, preventing bleeding. In the coagulation zone, the fallopian tube and its mesentery are cut off.

The excised tube is removed through laparoscopic instruments. If it is large, then removal in parts is allowed. After removing the affected organ, the abdominal cavity is examined, clots and liquid blood are sucked out, and the surface of the peritoneum is washed with saline solution. Finally, the instruments are removed from the punctures and sutures or staples are applied.

There are several types of organ-preserving laparoscopic interventions for ectopic tubal pregnancy:

1. Linear salpingotomy;
2. Removing a pipe fragment;
3. Extrusion of the embryo from the ampullary part of the organ.

At linear salpingotomy After introducing the instruments and inspection, the pipe is grabbed and a longitudinal section of its wall is made. The embryo is removed with an aspirator or with liquid. After complete removal of fetal tissue, the surgeon must ensure that there is no bleeding, remove clots from the abdomen, if any, and rinse it. The fallopian tube is not sutured, and the integrity of its wall is restored naturally.

Segmental resection indicated for patients wishing to preserve their fertility. This is the first stage of treatment, which will be followed by plastic surgery to restore the patency of the organ. Considering the overall cost of such treatment and the availability of effective reproductive technologies, doctors have rarely resorted to resection. It is mainly used after linear dissection for unstoppable bleeding and severe structural changes in the tube wall.

The surgeon grasps the area where the fertilized egg is located with clamps, then coagulates the wall of the tube and its mesentery and cuts off the affected area. It is also possible to use ligatures (loops), which tighten the tube along the periphery of the embryo.

Segmental resection should be followed by plastic surgery to restore the integrity of the organ. The conditions for its implementation are that the length of the surviving pipe sections is no less than 5 cm and the ratio of their diameters is no more than 1:3.

Squeezing out the fertilized egg is considered the most traumatic method of removing fetal tissue, which has a high risk of leaving fetal elements in the tube and bleeding. Squeezing out fetal tissue is justified when a tubal abortion has begun, when the embryo itself begins to separate from the wall of the tube, as evidenced by the accumulation of blood.

Removal of the embryo by extrusion is carried out using clamps that are gradually moved to the end of the tube opposite the uterus. Required condition manipulation is to ensure the patency of the outer section of the pipe. After removing the embryo, the tube is washed and its patency is checked (hybrotubation). The final stage of the operation is pelvic lavage, as a result of which the embryo is also removed.

Laparoscopic tubotomy surgery lasts about half an hour; much longer may be required for tubal plastic surgery.

In addition to tubal pregnancy, other types of ectopic pregnancy are possible - in the ovary, peritoneum, and uterine ligaments. Operations in this case can also be both open and laparoscopic and consist of resection of a section of the ovary, removal of the fertilized egg from the surface of the peritoneum, etc. These interventions are not as diverse as with tubal localization of the embryo, since in the latter case the surgeon aims not only to remove abnormal pregnancy, but also preserve reproductive ability.

Video: ectopic pregnancy, laparoscopic surgery 18+

Possible complications and postoperative period

Surgeries on the pelvic organs are unsafe, and if they are performed urgently for health reasons, the frequency of complications and adverse consequences increases. Perhaps the most safe option Treatment of tubal pregnancy is considered to be complete removal of the tube, while plastic surgery is associated with the risk of certain complications.

In many ways, the final result depends on the level of qualifications and skills of the surgeon, who may not be proficient in some modern tubal plastic techniques or have no experience working with laparoscopic equipment.

Most dangerous complication during the intervention, bleeding is considered, which can cause shock, therefore primary task if a pipe ruptures, bandage the damaged vessel and stop blood loss. Usage vasoconstrictor drugs during surgery increases the likelihood of systemic circulatory disorders.

In a short-term tubal pregnancy, when the tube has not ruptured, the cause of bleeding may be non-radical removal of chorion elements. To prevent this complication, the surgeon thoroughly “washes” the tube with a saline solution to which oxytocin has been added.

If the operation is performed laparoscopically using a coagulator, then there is a risk thermal burn tube tissue, ovarian ligament. Subsequently, such burns lead to overgrowth of the organ lumen, adhesions and infertility.

The main consequences after any type of treatment for ectopic pregnancy are the development of adhesions in the pelvis, the tube itself, provided it is preserved, as well as infertility. Possible repeat pregnancy in an already modified pipe. Prevention of these processes begins during surgery - administration of Ringer's solution, complete removal of blood clots. Repeat laparoscopy is possible after 24-48 hours.

Surgeries for ectopic pregnancy are usually performed free of charge in gynecological departments, but unlike many other diseases, there is no priority or quota for such treatment. The diagnosis can be made at the time of a pipe rupture and massive bleeding, so there is no question of payment for treatment - surgeons save, first of all, the patient’s life by performing emergency surgery.

However, it is possible to remove a tubal pregnancy for a fee. The cost of the procedure depends on the desired end result and the technical capabilities of achieving it. So, Removing the tube or cutting it to remove only the fertilized egg will cost about 30 thousand rubles. Laparoscopic tubectomy – from 1 5 to 80 thousand, depending on the comfort level of the chosen clinic, the qualifications of the doctor and the cost of the equipment.

Violations of the health of the female reproductive system can cause various problems during conception. One of these pathologies is pregnancy, in which the embryo is implanted in the ectopic cavity, and in the process of its development can lead to dire consequences.

Using modern diagnostic and therapeutic methods, it is possible to minimize the consequences of pathological conception and give a woman a much greater chance of becoming pregnant again. Laparoscopy for ectopic pregnancy saved many patients from the loss of important reproductive organs and the long recovery process after operations.

About ectopic pregnancy

An ectopic pregnancy, that is, displaced ectopic in Greek, in most cases occurs in the presence of pathological changes in the woman’s reproductive organs.

Factors contributing to the occurrence of this pathology include:

• Inflammatory processes of the uterus and appendages, leading to swelling of the tubes, fusion of the mucous membrane and deformation due to the formation of adhesions. This leads to obstruction of the tube and a decrease in its contractile function. As a result, the transport of the egg is disrupted. The most common cause of this pathology is chlamydia.
• Neoplasms of the uterine appendages. By squeezing the tube, they reduce its lumen, which prevents the passage of the egg.
• Endometriosis - overgrown cells interfere with the movement of the egg.
• Previously undergone major surgical operations.
• Congenital anomalies of the reproductive system.
• Endocrine disorders.

Depending on the site of attachment of the fertilized egg, abdominal, ovarian and tubal pregnancy are distinguished. The latter pathology is the most common - in 96% of cases.

The chorion (the outer shell of the embryo) attaches to the organ and begins to grow and develop. In the female body, other than the uterus, there is no organ capable of ensuring such a process. Chorionic villi gradually grow into blood vessels, cause bleeding and lead to a violation of the integrity, and subsequently to rupture of the organ.

If this is the fallopian tube, then it stretches as the embryo grows to a certain size, and then ruptures. In certain cases, spontaneous abortion can occur - the embryo peels off from the wall. Such conditions pose a danger to the patient’s health and the pregnancy must be terminated as quickly as possible, that is, the embryo must be removed while it is possible to do this with the least loss to the body.

When is intervention necessary?

Conception outside the uterine cavity may be accompanied by symptoms that are in many ways similar to normal. It's swelling mammary glands, irritability, changes in taste and smell, drowsiness, etc. But it allows one to suspect a parallel pathology. This is in most cases atypical symptoms for a normal pregnancy.

These include bloody, spotting discharge from the genitals, pain of various types, localized in the lower abdomen. The pain can radiate (give) to the rectum and is often accompanied by weakness, nausea, loose stool. Sometimes, due to the similarity with the symptoms of the threat of termination of a normal pregnancy, inflammatory processes in the appendages, ovarian dysfunction or any other pathologies, it is not possible to establish the correct diagnosis in time.

Taking an anamnesis is the first stage of differential diagnosis of the condition

When the fallopian (uterine) tube ruptures and intra-abdominal bleeding begins, the symptoms of the third group join the first two groups. This includes sharp pain in the lower abdomen, radiating (radiating) to the rectum, shoulder blade, shoulder, cold sweat and even sometimes loss of consciousness.

A pregnant woman's blood pressure drops sharply and her pulse quickens. The skin becomes pale, there are severe pain in the abdomen upon palpation. With such symptoms, urgent consultation with a specialist is required in order to have time to provide necessary help and prevent the development of complications in the form of bleeding or shock from pipe rupture.

Laparoscopy as the most effective treatment method

With the introduction of laparoscopic examination techniques into medicine and its use for surgical operations, many women managed to save their tubes and give hope for reconception. Today, several methods are used in medicine to remove ectopic pregnancy. A few years ago this was done using laparotomy - they opened the abdominal wall and removed the embryo.

Often this entailed the simultaneous removal of the tube along with the fetus, and in certain situations even the ovary.

TO this method They are still resorted to today, when the patient’s condition is critical and there is insufficient time for any other actions or due to the lack of proper equipment in the clinic. The use of laparoscopy for ectopic pregnancy has already firmly established itself as a convenient and less traumatic technique for both specialists and patients.

Carrying out punctures - important stage surgical intervention

The laparoscopic method of removing an ectopic pregnancy involves making 3 punctures in the abdominal wall - this is also a kind of surgical intervention, but it leaves virtually no scars and the recovery process is reduced significantly. Surgical ways to remove the embryo include milking, tubotomy, tubectomy and laparoscopy, which are prescribed depending on the indications and desires of the patient at the moment.

Milking

Translated, it means extrusion; this method is used for detachment of the embryo - it is removed from the pipe by extrusion, without damaging its integrity. This method is acceptable when developing fetus is located near the exit from the fallopian tube and at the same time the embryo detached. The determining points for choosing this method are an ectopic pregnancy that has stopped developing and has been exfoliated.

Tubotomy

The second name for this method is salpingotomy - it is used when it is not possible to squeeze out the embryo due to its size or location. The tube is cut at the site of attachment of the fetus, it is removed, and the fallopian tube is sutured. If the embryo is already large enough at this time, then it has to be removed along with part of the pipe. This technique ensures both the preservation of the pipe and its full functioning. The likelihood of getting pregnant after a tubotomy remains, but is slightly reduced.

Tubectomy

This is a surgical intervention that entails the removal of a tube during conception outside the uterus. This method has to be resorted to when preservation of the tube is impossible, and it is excised along with the embryo. Tuboectomy is often used for repeated pathological pregnancy, and especially difficult situations may be accompanied by removal of the ovary to save the patient’s life.

It is considered the most gentle method for getting rid of a pregnancy developing outside the uterus, since it does not require incisions in the abdominal cavity (they are replaced with punctures), and it is possible to preserve the tube with its full functionality. And beyond this, laparoscopy is the most reliable diagnostic technique with ectopic conception.

This type of intervention has fewer postoperative complications

The role of various types of laparoscopy in preserving women's health

The combination of diagnostic and operable methods of laparoscopy for ectopic pregnancy makes it practically irreplaceable and capable of saving the life and reproductive function of many patients.

Laparoscopic diagnosis

The capabilities of laparoscopic examination allow a visual assessment of the condition of the uterus and fallopian tubes. At the same time, it makes it possible to determine the presence of blood in the abdominal cavity, as well as to clarify its quantity, which helps in as soon as possible determine the most appropriate tactics for the operation.

Previously, there was only one method of treating ectopic pregnancy - removing the tube along with the fertilized egg. And if she conceived again outside the uterus, the woman completely lost the ability to become pregnant on her own. Today, the capabilities of laparoscopy (optical magnification of the operated object, the presence of miniature instruments) help in many, even quite complex cases, to keep the tube in a fully functional state and give the woman a chance for a successful conception.

Laparoscopy during surgery

If a pathologically attached pregnancy could not be detected in time, and it has developed to a large size, then the tube changes to a state in which normal functioning in the future is not possible. Theoretically, in this case, it is possible to perform a tubotomy and save the tube. But with such disturbances in the structure, it will not be able to ensure the reproductive performance of the system and will most likely lead to a repetition of the sad situation.

Laparoscopy provides an objective assessment of the condition of the tube and the advisability of its preservation. This technique becomes indispensable for conception outside the uterus, allowing tubectomy to be used only in extreme cases when removal of the tube is the only option.

Features of surgical treatment

A confirmed diagnosis of ectopic pregnancy requires an immediate decision to perform surgery. The goals of surgery include removing the embryo, restoring the anatomical norm of the fallopian tube or other involved organs, stopping possible bleeding, and thoroughly examining the abdominal cavity and pelvic organs.

To perform laparoscopy, it is necessary to make three small incisions - one in the umbilical region of approximately 12 mm, and two in the lower abdomen - in the right and left iliac regions. Using these incisions, the surgeon penetrates the abdominal cavity, piercing the peritoneum with special tubes of various diameters - trocars. They provide working channels for laparoscopic instruments: scissors, clamps, coagulants and a special video camera (laparoscope).

The intervention is performed for both diagnostic and therapeutic purposes.

The video camera transmits a detailed image of the abdominal cavity to the monitor, and the surgeon performs the operation, looking not at the surgical field as before, but at the monitor screen. To perform such manipulations, there must be enough free space in the abdominal cavity, and this is created by introducing carbon dioxide. After the surgeon’s work is completed, the gas is removed from the cavity through trocars.

Such operations are performed using anesthetic agents, which completely relieves the patient of any sensations. In certain cases, spinal anesthesia is used, in which an injection is made at the level of the lumbar region and the drug is injected into the spinal canal. With this type of anesthesia, the patient is conscious, but she has no sensitivity during the operation.

Possibilities of laparoscopy after surgery and additional benefits

After completing the main stage of the operation, thorough hemostasis (stopping bleeding) is performed. The entire abdominal cavity is scrupulously cleaned of blood and clots using disinfectant solutions.

When found gynecological diseases that require surgical intervention (endometriosis, cysts, adhesions, etc.), they are treated.

At the same time, all accessible organs are examined for the presence of concomitant diseases and, if necessary, operative method. Minimized injuries skin and internal membranes, meticulous sanitation of surgical wounds and the abdominal cavity provide easy postoperative period and rapid recovery of the body.

After laparoscopy, patients do not have to use a large number of painkillers, women quickly restore lost activity, and the likelihood of adhesions is minimized. The whole range of advantages of this technique ensures speedy rehabilitation and favorable preparation for subsequent conception.

Recovery period

To recovery period passed faster and more effectively; a whole range of procedures and recommendations was prescribed. The postoperative period after this pathology lasts approximately 5-7 days. On the seventh day, the stitches are removed. For two weeks after surgery, the wounds are treated with iodine and should not be exposed to prolonged wetness. Therefore, the patient is recommended to take a shower.

For the first few weeks, experts recommend sticking to a gentle diet and refraining from eating fatty, hot and spicy foods.

You can be sexually active after the menstrual cycle has been restored—at the end of the first menstruation of the postoperative period. After this surgical intervention, plan next pregnancy costs no earlier than 3–4 months, in the absence of contraindications from specialized specialists.

In some cases, a woman can become pregnant 1–2 months after surgery, even if her periods have not yet returned. But in any situation, strict control by a gynecologist is necessary in order to recognize in time possible violations and give appropriate recommendations.

Regardless of what type of surgical intervention was performed to get rid of an ectopic pregnancy, to stabilize the functions of the reproductive system it is necessary to drug therapy, as well as physical therapy.

One of the irreplaceable types of physiotherapy is magnetic therapy - it has a strong anti-inflammatory effect and prevents the formation of adhesions. Magnetic therapy helps maintain the functioning of the tube at the proper level, and this is very important especially in the case when the patient was left alone after the operation and there was severe bleeding.

Therapy after ectopic conception can take a long time. An important point is contraception, since you should abstain from subsequent pregnancy for at least six months for complete restoration of the genital organs.

To restore the patency of the fallopian tubes and prevent difficulties with conception, it is necessary to undergo a rehabilitation process, which, in addition to physical therapy, includes taking anti-inflammatory and anti-adhesive medications.

Of course, the possibilities of modern medicine in the form of laparoscopy give a woman a much greater chance of successfully becoming pregnant after an ectopic pregnancy. Thanks to new surgical techniques that ensure almost 90% preservation of the tubes, the level of infertility and the risk of repeated conceptions outside the uterus are significantly reduced. Even women who, as a result of ectopic conceptions, are left without both fallopian tubes should not despair, because they can become pregnant using in vitro fertilization and carry a healthy baby.

Technologies actively used in modern surgery have not bypassed obstetrics and gynecology - one of them is laparoscopy. Since the internal genital organs are located in the pelvic area, which freely communicates with the abdominal cavity, access to them is carried out in this way. But traditional incisions were too large and traumatic, so doctors resorted to them only in emergency situations.

During laparoscopy, all manipulations are carried out under the control of endoscopic equipment special tools passed through probes. This requires only a few small punctures on the abdominal wall, which are performed using a trocar. Therefore, this technology has become widespread not only as a method of surgical treatment, but also as an effective diagnostic procedure.

Laparoscopy is used especially effectively for ectopic pregnancy - although it is the equivalent of surgery, there is no more informative method besides it. The growth in popularity is due to its combined nature - if pathological changes are confirmed, parallel treatment measures are possible. Therefore, elimination of ectopic pregnancy and correction of its complications is currently performed primarily through laparoscopic access.

Concept of method

Patients do not always correctly imagine the technology of the upcoming intervention, as a result of which an appropriate attitude towards it develops. Laparoscopy is considered a surgical option, so preparation for it is carried out in a standard way. A full examination of the patient is carried out in advance to eliminate the risk of possible complications from the procedure.

Depending on how the ectopic pregnancy proceeds, the intervention can be performed in two variations. Each of them has a different volume of manipulations, as well as its own indications for implementation:

1. Regardless of the type, anesthesia is first performed - usually combined general anesthesia is used. In this case, a rapid induction of anesthesia is carried out using drugs administered intravenously, after which this state is maintained by inhalational anesthetics.
2. Diagnostic laparoscopy for ectopic pregnancy is performed quite rarely - it is a last resort when it is not possible to confirm the diagnosis by other means. In this case, only two probes are inserted into the abdominal cavity - with an endoscopic camera and a clamp for moving organs.
3. Therapeutic laparoscopy is used to surgically eliminate a progressive pregnancy, as well as correct complications that have arisen - tubal abortion or rupture of the fallopian tube. In this case, four ports are used - through them an endoscopic camera, a clamp and a pair of working instruments are inserted.

The diagnostic option of the procedure can be immediately expanded to a therapeutic option if, during the examination, complications of an ectopic pregnancy requiring emergency care were discovered.

For diagnostic purposes

According to the protocol for examining women in whom an ectopic pregnancy is suspected, laparoscopy is allowed to be performed only at the fourth stage. Previously, the patient must undergo a survey and examination by an obstetrician and a transvaginal ultrasound, after which she should be sent for diagnostic hysteroscopy or determination of the level of hCG in the blood. If these studies do not confirm the diagnosis, then indications for laparoscopy are determined:

• If the results of endometrial scraping obtained during hysteroscopy and histological description show signs of ectopic (outside the uterine cavity) implantation of the fertilized egg. These include reverse structures development of three stages, Overbeck's light glands, the Arias-Stella phenomenon, as well as the plexus of spiral vessels.
• Increased content in blood hCG up to 10 mIU/ml (but not higher than 2000) with the simultaneous absence of ultrasound signs of a normal “uterine” pregnancy.

In obstetric practice, the second indication is used much more often - the analysis gives a quick and reliable result, which allows you to timely decide on further tactics.

Progressive pregnancy

Since the technique is visualizing, doctors focus on direct signs characteristic of pathology in typical cases. Typically, an ectopic pregnancy is diagnosed between 7 and 9 weeks, when changes visible through the endoscope camera already appear:

• An indirect manifestation of the disease is an increase in the vascular pattern and dilation of the veins in the area of ​​the broad ligament of the uterus, as well as the mesentery of the fallopian tube and ovary. Moreover, the changes are always one-sided, indicating the side of the lesion.
• In the area of ​​one of the uterine segments, a local thickening is visualized - most often in the widest and most voluminous ampullary section. It has a round or oval shape, and a bluish-pink color that stands out in contrast against the background color of normal tissue.
• The size of the formation can be varied, depending on the stage of pregnancy.

Of greatest interest is the localization of the process in the intramural region, which is located in the thickness of the uterine wall. In the early stages, the characteristic thickening can be almost imperceptible, plus it can be masked by the apparently healthy tissue of the pipe.

Interrupt

The outcome of an ectopic pregnancy is almost always spontaneous abortion, which can occur in several ways. The development of each of them is accompanied by a vivid clinical picture of an “acute abdomen.” This allows laparoscopy to be used urgently to determine the cause of the symptoms:

1. Incomplete tubal abortion is characterized by the identification of a typical thickening in shape, color and size in any part of the fallopian tube. Appearance the latter also changes - against the background of the pink and shiny peritoneum, its bluish color is noted. And from the opening of the tube, dark blood is released into the abdominal cavity, which is also found in the rectal-uterine cavity and the lateral recesses of the small pelvis.
2. With a complete tubal abortion, there is a decrease in the size of the fallopian tube while maintaining its pale bluish color. There is no longer any active bleeding detected from its opening. Near it or a little lower on the peritoneum of the small pelvis, a fertilized egg is found - a dense round clot with a purplish-blue color.
3. The most unfavorable scenario is a rupture of the fallopian tube. Laparoscopy reveals a defect in its wall with uneven edges, and there are signs of active bleeding.

If signs of complications are detected during the diagnostic procedure, the intervention immediately takes on a therapeutic nature. Depending on the conditions, radical or gentle surgical techniques are performed.

For the purpose of treatment

With the development of surgical techniques, the use of laparoscopy now has virtually no restrictions. The only absolute contraindication to it is hemorrhagic shock in a woman, which requires full intervention. The adhesive process in the pelvic cavity is only a relative limitation - with sufficient experience of the doctor, it is not a serious obstacle.

Previously, open access surgeries were widely used to treat complications of ectopic pregnancy. Thanks to a number of advantages that completely cover the disadvantages, the laparoscopy method is gradually replacing it from practice:

• Small incisions and a shortened duration of intervention determine a parallel reduction in the incidence of early and late complications. This allows for effective surgery in women, without fear of developing life-threatening consequences.
• Laparoscopy makes it possible to carry out sparing operations much more often, as a result of which it is possible to preserve the function of the fallopian tube.
• A small amount of intervention reduces the body’s recovery time, ensuring acceleration of physical and social rehabilitation. Consequently, early activation of the patient in combination with careful manipulations reduces the likelihood of the formation of adhesive disease.

According to the expected outcome of the operation, there are two options for laparoscopy - radical, implying complete or partial removal of the altered tube, or organ-preserving.

Types of operations

The expected extent of intervention is usually determined in advance, although in some cases it may change during a diagnostic examination of the changes. Therefore, even before the start of manipulations, the doctor already assumes what therapeutic actions he will perform:

1. “Conservative” operations include squeezing out the fertilized egg (only when it is located in the ampoule), and tubotomy - cutting the fallopian tube and removing the pathological formation. They are carried out only if possible contraindications have been excluded, as well as the absence of complications confirmed during examination.
2. Radical operations involve either resection of a section of the fallopian tube or tubectomy—its complete removal. Their implementation is indicated for repeated tubal pregnancy, detected scar changes, rupture of the tube, the size of the ovum is more than 3 centimeters, as well as its location in the intramural region.

A relative indication for radical intervention is the woman’s personal desire - if she does not plan a pregnancy in the future, and provided she has children. In this case, to reduce the likelihood of complications, the affected fallopian tube is immediately removed.

Every woman at some point in her life wants to become a happy mother, to experience all the joyful moments of pregnancy and motherhood. Collateral successful pregnancy is the proper prevention of gynecological diseases. Along with prevention, rehabilitation after various surgical interventions remains very important. Naturally, in a hospital setting, a woman is provided with appropriate assistance for get well soon. Various conservative treatment methods are used to prevent the development of infectious complications in the postoperative period. However, to fully recover from an ectopic pregnancy, a woman’s body needs more than standard treatment principles. That is why, today the use of physiotherapy methods, alternative medicine etc. became one of the components of comprehensive rehabilitation. Today we will pay attention to various methods of restoring the body not only after surgery due to ectopic pregnancy, but in general, for any other disease or surgical operation.

Everyone knows that even after minor intervention, a woman’s body experiences severe stress, which can provoke a number of unpredictable complications and conditions that limit the possibility of another pregnancy. Many sources treat two stages of the postoperative period: primary and secondary. In the first case, the patient’s recovery process takes place directly in the gynecological department, where she is transported from the operating room, and she remains there until complete recovery. Under the strict guidance of a gynecologist, the patient undergoes a course drug treatment to create optimal conditions for the wound healing process in order to return to physical and mental “shape”.

However, we should not forget about the secondary stage of the postoperative period, which begins in other specialized institutions, the work of which is based on non-drug methods of treatment and prevention after illnesses or surgical operations. On this moment the range of services provided by such rehabilitation centers is so diverse that, if desired, a woman who has had an ectopic pregnancy can shorten her rehabilitation course by almost several times, in contrast to independent recovery.

Natural, natural ingredients– various therapeutic muds, waters from mineral springs, herbal medicines, sea salts, etc. - carry the most positive influence on the woman’s body after surgical operations, at the same time acting carefully and effectively. Many sources note the beneficial effects of mineral and thermal baths, a high rate of healing, and stimulation hormonal levels, or rather its normalization, also providing analgesic, antitoxic and other effects. After an ectopic pregnancy, this method is one of the main ones in complex rehabilitation. The phenomenon of physiotherapy in the modern world has long been proven, its influence on the reactive forces of the body, activation of the protective resources of the female reproductive system, etc. Often in individual program rehabilitation of the patient can be found - all kinds of massages, general or limited areas of the body, as well as reflexology, thanks to which blood circulation in the pelvis is remarkably improved, skin regeneration is accelerated, which can only benefit a woman, especially after laparotomy surgery.

The entire rehabilitation technique is based on a very important psychological aspect. The fact is that the primary postoperative period leaves a significant imprint on a woman, after undergoing pain, stressful situations, long-term use of medications and their consequences. Therefore, of course, when the patient finds herself in the comfortable conditions of a specialized institution for further recovery, where delicate and gentle methods of treatment such as physiotherapy or homeopathy are used as therapy, it is much easier and easier for patients to accept this form of treatment. Which cannot but affect your health. It will have a positive effect. During the entire period of physical recovery, the woman also recovers psychologically, preparing herself for the future desired motherhood. Therefore, you should not deprive yourself of such pleasure, but do everything necessary for your own health and a happy future.

We wish you good health and spiritual harmony. We are waiting for responses, reviews and comments on the topic of the article. Don't forget to share links to the material on social networks.

When a patient is going for laparoscopy, she always wants to know what awaits her and what the features of this procedure are. Many people are also interested in information about the rehabilitation period. We will tell you about this in the article.

Laparoscopy for ectopic pregnancy

To confirm the pathological gestation of the fetus by 100% and perform the appropriate operation to remove the ectopic pregnancy, laparoscopy is used. This is a modern diagnostic and treatment method that allows you not to resort to classical surgery.

The main purpose of laparoscopy for an abnormal pregnancy is to localize internal bleeding and to remove the tube where the ectopic pregnancy was located. Ideally this method allows you to cut out only part of the fallopian tube with the fertilized egg, although in severe cases complete removal of the tube may be required.

The sooner a pathological pregnancy is determined and the ectopic pregnancy is removed laparoscopically, the higher the chances of avoiding removal of the fallopian tube.

How is laparoscopic surgery performed?

The advantages of laparoscopy cannot be overestimated, since examination using a device such as a laparoscope allows you to really see the condition of all the necessary organs: the uterus, fallopian tubes, as well as the presence of blood in the abdominal cavity and its quantity. In addition to a timely and accurate diagnosis, laparoscopy provides great opportunity apply the most gentle, best for the patient’s health surgical tactics. Not many years ago, the only known and then used method of treatment was removal of the fallopian tube during a pathological pregnancy along with the fertilized egg. If the second fallopian tube was eliminated, the patient would forever lose the chance to conceive a child. traditional way. Today, the possibilities of laparoscopic manipulation in many cases make it possible to leave the fallopian tube intact and increase the chances of successful conception further. The specialist performs actions with miniature instruments with optical magnification, acting in the interests of the patient’s health.

Many people are interested in how the operation to remove an ectopic pregnancy is performed. What methods exist and how do they differ from each other? Laparoscopy for pathology is performed only if the fertilized egg is in the fallopian tube, that is, with tubal ectopic gestation. There are two methods of laparoscopy:

1. Tubotomy is a laparoscopic method in which a specialist opens the uterine tube and removes the fetus, after which he cleanses the entire abdominal cavity of egg remnants and blood clots.
2. Tubectomy is a laparoscopic method used in case of serious damage to the fallopian tube with its subsequent mandatory removal.

If we talk about how long the operation for an ectopic pregnancy lasts, then we can only give an approximate figure. Everything is very individual. Depends on the degree of complexity and characteristics of the patient’s body.

The recovery period after laparoscopy is easier than with traditional gynecological surgery. In the first case, ability to work returns after two or three weeks. Whereas in the second, the patient will be able to return to to the usual way life in only two months.

Rehabilitation after laparoscopy

Treatment after surgery to remove an ectopic pregnancy should be comprehensive. As for the postoperative period for this manipulation, it is about 5-7 days. Literally on the seventh day after the operation, the specialist removes the stitches. During the first two weeks after laparoscopy, it is recommended to treat wounds with iodine solution and refrain from taking a bath, using only a shower. The first weeks are also better to stick to light diet. Sexual relations after laparoscopic surgery are possible only after the menstrual cycle has been restored, that is, when the first menstruation, which began in the postoperative period, ends. In general, it must be said that the recovery period for removal of an ectopic pregnancy after surgery is very important.

It will be possible to plan a pregnancy 3-4 months after the operation, provided there are no health problems and with the permission of the treating specialist. However, in some cases, conception after surgery occurs after 1-2 months. One way or another, consultation with a specialist after laparoscopy is mandatory.

Such medical manipulation in case of pathological pregnancy is practically irreplaceable, since it allows to minimize the negative consequences after surgery to eliminate an ectopic pregnancy for female body. If after a few days the patient notices suspicious discharge after surgery to remove an ectopic pregnancy, she will need to consult a doctor.