Perioperative Results of Patients Undergoing Laparoscopic Cornual Resection and Cornuotomy in Cornual Pregnancy; Three Years Experiences of a Tertiary Referral Center

Cornual pregnancy is a rare form of ectopic pregnancy that accounts for 2 to 4% of ectopic pregnancies, with a mortality rate of 2.0 to 2.5%. Traditionally, interstitial pregnancies were treated by medical treatment (methotrexate) or by laparotomy, cornual resection or hysterectomy. We aimed to report perioperative outcomes in these series of patients treated with laparoscopic surgery for cornual ectopic pregnancy. The data of the patients who underwent laparoscopic surgery for interstitial pregnancy (n=10) were retrospectively reviewed. Demographic characteristics of the patients such as age, gravida, parity, predisposing factors were examined. Complaints of admission, operation and duration, preoperative and postoperative hemoglobin levels, size of pregnancy materials, length of hospital stay and complications were evaluated. Eight patients underwent laparoscopic cornual resection and two patients underwent laparoscopic cornuotomy. The mean age of the patients included in the study was 29.5±4.0 years, gravida 2.2±1.1, parity 0.7±0.82, delta hemoglobin 1.19±0.57 g/dl. Abnormal bleeding and inguinal pain were the most common symptoms in symptomatic patients. The mean operation time was 64.5±22.6 (40-120) minutes. The mean hospital stay of the operated patients was 2.7±0.67 days. Laparoscopic treatment of cornual ectopic pregnancies is an appropriate and safe treatment option. In our experience, the laparoscopic approach minimizes overall blood loss without causing trauma and allows a bloodless area f or anatomic restoration. We believe that laparoscopic cornual resection and cornuotomy can be performed successfully in the hands of experienced surgeons and the future fertility chances of the patients can be preserved.

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1. Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril 1999; 72: 207-215.

2. Tulandi T, Al-Jaroudi D. Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol 2004; 103: 47-50.

3. Soriano D, Vicus D, Mashiach R, et al. Laparoscopic treatment of cornual pregnancy: a series of 20 consecutive cases. Fertil Steril 2008; 90: 839-843.

4. Walker JJ. Ectopic pregnancy. Clin Obstet Gynecol 2007; 50: 89-99.

5. Lewis G, Drife J. Why Mothers Die 2000-2002. The Sixth Report of the Confidential Enquiries into Maternal Death in the United Kingdom. London, UK: RCOG Press; 2004.

6. Myung JK, Yong WJ, Jae-Ho C, et al. Successful management of heterotopic cornual pregnancy with laparoscopic cornual resection. European Journal of Obstetrics & Gynecology and Reproductive Biology 2016; 203: 199-203.

7. Cucinella G, Calagna G, Rotolo S, et al. Interstitial pregnancy: A „Road Map‟ of surgical treatment based on a systematic review of the literature. Gynecol Obstet Invest 2014; 78: 141-149.

8. Ng S, Hamontri S, Chua I, Chern B, Siow A. Laparoscopic management of 53 cases of cornual ectopic pregnancy. Fertil Steril 2009; 92: 448-452.

9. Damario MA, Rock JA. Surgery for obstetrics: ectopic pregnancy. In: Te Linde RW, Rock JA, Jones HW, editors. Te Linde‟s Operative Gynecology. 9th ed. Philadelphia, PA: LippincottWilliams &Wilkins 2003; 798-824.

10. Auslender R, Arodi J, Pascal B. Interstitial pregnancy: early diagnosis by ultrasonography. Am J Obstet Gynecol 1983; 15: 146: 717-718.

11. Timor-Tritsch IE, Monteagudo A, Matera C, Veit CR. Sonographic evolution of cornual pregnancy treated without surgery. Obstet Gynecol 1992; 79: 1044-1049.

12. Ackerman TE, Levi CS, Dashefsky SM, Holt SC, Lindsay DJ. An interstitial line: sonographic finding in an interstitial (cornual) ectopic pregnancy. Radiology 1993; 189: 83-87.

13. Lee MH, Im SY, Kim MK, Shin SY, Park WI. The comparison of laparoscopic cornual resection and cornuotomy for interstitial pregnancy. J Minim Invasive Gynecol 2017; 24: 397-401.

14. Wang J, Huang D, Lin X, et al. Incidence of interstitial pregnancy after in vitro fertilization/embryo transfer and the outcome of a consecutive series of 38 cases managed by laparoscopic cornuostomy or cornual repair. J Minim Invasive Gynecol 2016; 23: 739-747.

15. Watanabe T, Watanabe Z, Watanabe T, Fujimoto K, Sasaki E. Laparoscopic cornuotomy for interstitial pregnancy and postoperative course. J Obstet Gynaecol Res 2014; 40: 1983-1988.

16. Afifi Y, Mahmud A, Fatma A. Hemostatic Techniques for Laparoscopic Management of Cor nual Pregnancy: Double-Impact Devascularization Technique. J Minim Invasive Gynecol 2016; 23: 274-280.

17. Tulandi T, Vilos G, Gomel V. Laparoscopic treatment of interstitial pregnancy. Obstet Gynecol 1995; 85: 465.

18. Grobman WA, Milad MP. Conservative management of a large corneal pregnancy. Hum Reprod 1998; 13: 2002-2024.

19. Gleicher N, Karande V, Rabin D, Pratt D. Laparoscopic removal of twin cornual pregnancy after in vitro fertilization. Fertil Steril 1994; 61: 1161-1162.

20. Weissman A, Fishman A. Uterine rupture after conservative surgery for interstitial pregnancy. Eur J Obstet Gynecol Reprod Biol 1992; 13: 237- 239.

21. Karaman E, Gülaç B, Karaman Y, Hendem DU, Han A. The Management of Cornual Ectopic Pregnancy: Two Case Reports. İKSST Derg 2014; 6: 49-53.