Objective: Cesarean scar pregnancy (CSP) can have catastrophic consequences, but a standardized diagnosis and treatment for CSP are lacking. At least 10 different treatments are currently available, further confusing treatment selection. The aim of this study was to compare the outcomes of using laparotomy or laparoscopy to treat CSP.
Methods: We reviewed data from 935 patients with suspected CSP from 1 January 2013 to 31 December 2018. A total of 278 patients were included in the study, of whom 121 were treated with laparoscopy and 157 were treated with laparotomy. We compared and analyzed the characteristics of laparoscopic and open surgeries for treating CSP cases and the advantages and disadvantages of different vascular pretreatments.
Results: Intraoperative bleeding, the transfusion rate, total days of hospitalization and postoperative hospital length of stay were lower with laparoscopy than laparotomy (P < 0.05). There was no difference in the factors (beta human chorionic gonadotropin [β-HCG] decrease, reoperation rate and tissue residues) closely related to the success of the surgery in the two groups. Furthermore, we used different blood vessel pretreatments among patients. The rates of tissue residue, reoperation and intraoperative blood transfusion were lower in patients with temporary vascular occlusion than in patients with permanent vascular occlusion.
Conclusion: This study revealed that laparoscopic surgery is superior to laparotomic surgery for treating CSP. Patients in both groups benefited from temporary arterial occlusion. Thus, temporary arterial occlusion with laparoscopic surgery may be the best treatment for CSP.
Keywords: cesarean scar pregnancy, hysterotomy, laparoscopy, laparotomy, arterial occlusion