Table 8.4GRADE summary of findings for comparison of laparotomy with laparoscopy for the management of tubal ectopic pregnancy

Number of studiesNumber of women or mean (SD)EffectQuality
LaparotomyLaparoscopyRelative

(95% CI)
Absolute

(95% CI) and P-value if reported
Subsequent viable intrauterine pregnancy
1 meta-analysis of 2 studies

(Lundorff et al., 1992;Vermesh & Presser, 1992)
27/66

(40.9%)
26/61

(42.6%)
RR 0.96

(0.64 to 1.45)
17 fewer per 1000

(from 155 fewer to 191 more)
Low
Subsequent intrauterine pregnancy
1 meta-analysis of 2 studies

(Lundorff et al., 1992; Vermesh & Presser, 1992)
35/66

(53%)
35/61

(57.4%)
RR 0.92

(0.68 to 1.26)
43 fewer per 1000

(from 186 fewer to 152 more)
Low
1 study

(Chatwani et al., 1992)
12/35

(34.3%)
9/33

(27.3%)
RR 1.26

(0.61 to 2.59)
70 more per 1000

(from 106 fewer to 433 more)
Very low
1 study

(Mehra et al., 1998)
11/25

(44%)
46/86

(53.5%)
RR 0.82

(0.51 to 1.33)
95 fewer per 1000

(from 264 fewer to 179 more)
Very low
1 study

(Murphy et al., 1992)
5/10

(50%)
7/8

(87.5%)
RR 0.57

(0.29 to 1.12)
375 fewer per 1000

(from 620 fewer to 105 more)
Very low
Recurrent ectopic pregnancy
1 meta-analysis of 2 studies

(Lundorff et al., 1992; Vermesh & Presser, 1992)
9/66

(13.6%)
5/61

(8.2%)
RR 1.66

(0.59 to 4.69)
54 more per 1000

(from 34 fewer to 302 more)
Low
1 study

(Mehra et al., 1998)
1/25

(4%)
4/86

(4.7%)
RR 0.86

(0.10 to 7.35)
7 fewer per 1000

(from 42 fewer to 295 more)
Very low
1 study

(Murphy et al., 1992)
2/10

(20%)
0/8

(0%)
RR 4.09

(0.22 to 74.78)
200 more per 1000

(from 155 fewer to 510 more)
Very low
Length of hospital stay (days)
1 meta-analysis of 2 studies

(Lundorff et al., 1991; Vermesh et al., 1989)
Means 5.4 and 3.3

(SD 1.5 and 1.1)

n = 87
Means 2.2 and 1.4

(SD 0.69 and 0.55)

n = 78
not calculable (NC)MD 2.55 higher

(1.28 to 3.83 higher)
Moderate
1 study

(Baumann et al., 1991)
Mean 5.2

(SD 1.4)

n = 27
Mean 1.7

(SD 1.2)

n = 65
NCMD 3.5 higher

(3.05 to 3.95 higher)

P < 0.001
Very low
1 study

(Chatwani et al., 1992)
Mean 4.70

(SD not reported (NR))

n = 61
Mean 1.27

(SD NR)

n = 56
NCMD 3.43 higher

(confidence intervals NC)

P < 0.05
Very low
1 study

(El Tabbakh & El Sayes, 2002)
Mean 5.25

(SD 3.16)

n = 23
Mean 2.14 (SD 1.81)

n = 184
NCMD 3.11 higher

(2.24 to 3.98 higher)
Very low
1 study

(Federici et al., 1994)
Mean 7.3

(SD 0.9)

n = 7
Mean 2.8

(SD 0.7)

n = 23
NCMD 4.5 higher

(3.84 to 5.16 higher)

P < 0.001
Very low
1 study

(Lo et al., 1999)
Mean 5.3

(SD NR)

n = 164
Mean 2.65

(SD NR)

n = 371
NCMD 2.65 higher

(confidence intervals NC)

P = 0.0001
Very low
1 study

(Mehra et al., 1998)
Mean 3.52

(SD 0.51)*

n = 25
Mean 1.48

(SD 0.59)*

n = 86
NCMD 2.04 higher

(1.80 to 2.27 higher)

P < 0.05
Very low
1 study

(Mol et al., 1997)
Mean 8.89

(SD 2.33)

n = 140
Mean 2.93

(SD 1.08)

n = 115
NCMD 5.96 higher

(5.49 to 6.43 higher)
Very low
1 study

(Murphy et al., 1992)
Mean 26.42

(SD 0.71)*

n = 37
Mean 1.08

(SD 0.79)*

n = 26
NCMD 25.34 higher

(24.96 to 25.72 higher)

P < 0.005
Very low
Need for further surgery
1 meta-analysis of 2 studies

(Lundorff et al., 1991; Vermesh et al., 1989)
3/87

(3.4%)
8/78

(10.3%)
RR 0.34

(0.09 to 1.22)
68 fewer per 1000

(from 93 fewer to 23 more)
Low
1 study

(Baumann et al., 1991)
0/27

(0%)
2/65

(3.1%)
RR 0.47

(0.02 to 9.51)
16 fewer per 1000

(from 30 fewer to 262 more)
Very low
1 study

(Federici et al., 1994)
0/7

(0%)
0/23

(0%)
NCNCVery low
1 study

(Lo et al., 1999)
1/164

(0.61%)
3/371

(0.81%)
RR 0.75

(0.08 to 7.20)
2 fewer per 1000

(from 7 fewer to 50 more)
Very low
1 study

(Murphy et al., 1992)
0/37

(0%)
2/26

(7.7%)
RR 0.14

(0.01 to 2.84)
66 fewer per 1000

(from 76 fewer to 142 more)
Very low
Need for methotrexate
1 study

(Lundorff, 1997)
0/57

(0%)
2/48

(4.2%)
RR 0.17

(0.01 to 3.44)
35 fewer per 1000

(from 41 fewer to 102 more)
Low
1 study

(Murphy et al., 1992)
0/37

(0%)
1/26

(3.8%)
RR 0.24

(0.01 to 5.6)
29 fewer per 1000

(from 38 fewer to 177 more)
Very low
Need for surgery, methotrexate or expectant management
1 study

(Mol et al., 1997)
1/140

(0.71%)
18/115

(15.7%)
RR 0.05

(0.006 to 0.34)
149 fewer per 1000

(from 104 fewer to 156 fewer)
Very low
Readmission to hospital
1 study

(Chatwani et al., 1992)
1/61

(1.6%)
1/56

(1.8%)
RR 0.92

(0.06 to 14.33)
1 fewer per 1000

(from 17 fewer to 238 more)
Very low
1 study

(Lo et al., 1999)
2/164

(1.2%)
8/371

(2.2%)
RR 0.57

(0.12 to 2.63)
9 fewer per 1000

(from 19 fewer to 35 more)
Very low
Abdominal pain
1 study

(Lundorff, 1997)
3/57

(5.3%)
1/48

(2.1%)
RR 2.53

(0.27 to 23.50)
32 more per 1000

(from 15 fewer to 469 more)
Low
Thromboembolic disease
1 study

(Mol et al., 1997)
1/140

(0.71%)
0/115

(0%)
RR 2.47

(0.1 to 60.02)
7 more per 1000

(from 26 fewer to 39 more)
Very low
Respiratory morbidity
1 study

(Mol et al., 1997)
2/140

(1.4%)
0/115

(0%)
RR 4.11

(0.2 to 84.83)
14 more per 1000

(from 20 fewer to 51 more)
Very low
1 study

(Murphy et al., 1992)
1/37

(2.7%)
0/26

(0%)
RR 2.13

(0.09 to 50.36)
27 more per 1000

(from 104 fewer to 138 more)
Very low
Need for a blood transfusion
1 study

(El Tabbakh & El Sayes, 2002)
6/23

(26.1%)
13/184

(7.1%)
RR 3.69

(1.56 to 8.77)
190 more per 1000

(from 40 more to 549 more)
Very low
1 study

(Mol et al., 1997)
10/140

(7.1%)
1/115

(0.87%)
RR 8.21

(1.07 to 63.22)
63 more per 1000

(from 1 more to 541 more)
Very low
1 study

(Murphy et al., 1992)
2/37

(5.4%)
1/26

(3.8%)
RR 1.41

(0.13 to 14.70)
16 more per 1000

(from 33 fewer to 527 more)
Very low
Intraoperative blood loss (millilitres)
1 study

(Vermesh et al., 1989)
Mean 195

(SD 131.45)

n = 30
Mean 79

(SD 98.59)

n = 30
NCMD 116 higher

(55.95 to 176.05 higher)

P < 0.001
Moderate
1 study

(Baumann et al., 1991)
Mean 269.0

(SD 258.90)

n = 27
Mean 206.1

(SD 235.0)

n = 65
NCMD 63 higher

(47.53 lower to 173.33 higher)

NS (P value NR)
Very low
1 study

(El Tabbakh & El Sayes, 2002)
Mean 270.7

(SD 138.4)

n = 23
Mean 79.6

(SD 96.7)

n = 184
NCMD 191.08 higher

(146.61 to 235.55 higher)

P < 0.0001
Very low
1 study

(Lo et al., 1999)
Mean 110.4

(SD NR)

n = 164
Mean 129.2

(SD NR)

n = 371
NCMD 18.8 lower

(confidence intervals NC)

NS (P value NR)
Very low
1 study

(Mehra et al., 1998)
Mean 150

(SD 44.9)

n = 25
Mean 140

(SD 51.9)

n = 86
NCMD 10 higher

(12.72 lower to 32.72 higher)

NS (P value NR)
Very low
1 study

(Murphy et al., 1992)
Mean 115

(SD 115)

n = 36
Mean 62

(SD 61)

n = 26
NCMD 53 higher

(3.45 to 102.55 higher)

P < 0.001
Very low
Length of hospital stay (days)
1 study

(Rizzuto et al., 2008)
All patients discharged after 3–4 days

n = 5
All patients discharged after 1–2 days

n = 32
NCNCVery low
Need for further surgery
1 study

(Rizzuto et al., 2008)
0/5

(0%)
0/32

(0%)
NCNCVery low

CI confidence interval, MD mean difference, NC not calculable, NR not reported, NS not significant, P probability, RR relative risk, SD standard deviation

*

Calculated by the NCC-WCH technical team from data reported in hours in the study

The results of Rizzuto et al., 2008 are reported separately due to the specific nature of the study population (women with a ruptured ectopic pregnancy and significant haemoperitoneum)

From: 8, Management of ectopic pregnancy

Cover of Ectopic Pregnancy and Miscarriage
Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage.
NICE Clinical Guidelines, No. 154.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG; 2012 Dec.
Copyright © 2012, National Collaborating Centre for Women's and Children's Health.

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