Laparoscopy or Laparotomy for High-risk Caesarean Scar Pregnancy: A Retrospective Study

Background: Caesarean scar pregnancy (CSP) can have catastrophic consequences. A standardized diagnosis and treatment for CSP are still lacking. The currently available treatment methods are confusing, and at least 10 different treatment measures exist. The aim of this study was to compare the outcomes of with laparotomy or laparoscopy in the treatment of high-risk CSP. Methods: We reviewed 935 patients with CSP from 1 January 2013 and 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.Results: We compared and analysed the characteristics of the laparoscopic and open surgeries in the treatment of high-risk CSP and the advantages and disadvantages of different methods of vascular pretreatment. Intraoperative bleeding, transfusion rate, total days of hospitalization and postoperative hospital stay were better in laparoscopy than in laparotomy (P < 0.05). There was no difference in the factors (β-HCG decrease, reoperation and tissue residues) closely related to the success of the surgery in the two groups. Furthermore, we pretreated blood vessels differently before the operation in some patients. Tissue residue, reoperation and intraoperative blood transfusion rates in patients with temporary vascular occlusion were better than in patients with permanent vascular occlusion. Conclusions: This study revealed that laparoscopic surgery is superior to laparotomic surgery in the treatment of high-risk CSP. Patients benefited from temporary arterial occlusion in both groups. Temporary arterial occlusion under laparoscopic surgery may be the best treatment for high-risk CSP.