To compare the clinical efficacy and fertility outcomes of laparoscopic segmental tubal resection with end-to-end anastomosis versus laparoscopic salpingotomy in patients with tubal pregnancy.

A retrospective analysis was conducted on 69 patients with tubal pregnancy who had a strong desire for future fertility and underwent surgical treatment at our hospital between January 2020 and January 2023. Among them, 29 patients underwent laparoscopic segmental tubal resection with end-to-end anastomosis (Group A), while 40 patients underwent laparoscopic salpingotomy with suture repair (Group B). Both groups received a 20 mg methotrexate injection into the mesosalpinx during surgery. Tubal patency was assessed via lipiodol hysterosalpingography 3 months postoperatively. Parameters compared included preoperative baseline characteristics, intraoperative blood loss, operative time, postoperative bowel recovery time, visual analog scale (VAS) pain score on postoperative day 1, incidence of persistent ectopic pregnancy within 2 weeks post-surgery, tubal patency status (classified as obstructed, partially patent, or patent) at 3 months, and rates of ultrasonographically confirmed intrauterine pregnancy (IUP) and recurrent ipsilateral ectopic pregnancy within 24 months postoperatively.

No significant differences were observed in preoperative baseline data, postoperative bowel recovery time, or VAS score on day 1 between the two groups (P＞0.05). Intraoperative blood loss was also comparable between the two groups (Group A: 39.1± 9.4 ml vs Group B: 35.2±13.1 ml; F=1.87, P=0.176). However, the mean operative time was significantly longer in Group A (58.7±18.0 min) than in Group B (43.6±17.3 min) (F=12.34, P=0.001). The incidence of persistent ectopic pregnancy was 0% in Group A and 7.5% in Group B, which showed no statistically significant difference (χ²=2.27, P=0.132). At the 3-month follow-up, the tubal patency rate was significantly higher in Group A (89.7%) compared to Group B (65.0%) (χ²=6.24, P =0.044). The IUP rate within 24 months was also significantly higher in Group A (89.7%) than in Group B (70.0%) (χ²=4.09, P=0.043). The recurrent ectopic pregnancy rates were 3.4% and 12.5% in Groups A and B, respectively, with no statistically significant difference (χ²=1.74, P=0.188). All procedures were completed successfully without severe adverse events.

Compared to salpingotomy, laparoscopic segmental tubal resection with end-to-end anastomosis, although requiring a longer operative time, is safe and effective. It significantly improves postoperative tubal patency and intrauterine pregnancy rates, with a trend towards reduced risks of persistent and recurrent ectopic pregnancy. This procedure can be considered a new surgical option for women of reproductive age with a strong desire for future fertility.