• Besides preventing death, the current focus in the surgical management of ectopic pregnancies includes preservation of fertility, rapid recovery and reduction of costs
• Laparoscopic salpingostomy and partial salpingectomy are gaining ground over laparotomy
• 90% of women with ectopic pregnancy and serum β-hCG levels of >200 IU/L require operative intervention owing to increasing symptoms or tubal rupture

Laparoscopy

• Preferred approach and is superior to laparotomy when considering recovery time, rate of subsequent IUP, and recurrent ectopic pregnancy

Laparotomy

• Surgery of choice for patients with compromised hemodynamic status or cornual ectopic pregnancy when laparoscopic approach is too difficult or if the surgeon is not trained in operative laparoscopy

Salpingostomy

• Standard laparoscopic procedure for unruptured ectopic mass of <4 cm in length by US
• Over the bulging anti-mesenteric border of the implantation site, a longitudinal incision is made and left unsutured
• Salpingostomy is reasonable if there is only one tube but it carries a risk of 20% of repeated ectopic pregnancy
• It may also be considered in women with a contralateral tubal damage or previous ectopic pregnancy, abdominal surgery or pelvic inflammatory disease 
• There is a 5-11% risk of persistent trophoblast (detected by decrease of β-hCG levels of <20% every 72 hours)
  • β-hCG level should be followed up until it becomes undetectable or decreases to <5 IU/L (5 mIU/mL)

Salpingectomy

• Indicated in patients with uncontrolled bleeding, extensive tubal damage, recurrent ectopic pregnancy in the same fallopian tube, severely damaged fallopian tube (eg isthmic ectopic pregnancies), ectopic gestation >5 cm, or as a sterilization procedure
• Salpingectomy is preferred if the contralateral tube is healthy because there is a lower rate of persisting trophoblast