Implications of perihepatic adhesions in women undergoing laparoscopic surgery for ectopic pregnancy.

OBJECTIVE To establish whether the finding of perihepatic adhesions (PHAs) at laparoscopy for ectopic pregnancy (EP) is associated with poor perioperative and reproductive outcomes. METHODS A retrospective cohort study was undertaken of all cases of EP managed surgically at a teaching hospital in northeast London in 2003-2013. Data for symptoms, reproductive history, ultrasonography findings, blood parameters, and findings at surgery were compared between patients with and without perihepatic adhesions (PHAs) identified at laparoscopy. RESULTS Among 802 women with EP, PHAs were identified during surgery for 60 (7.5%). Compared with women without PHAs, patients with PHAs were significantly more likely to have had previous pelvic inflammatory disease, previous EP, previous tubal surgery, and the finding of abnormal contralateral adnexa or other adhesions during laparoscopy (P≤0.024 for all). They also had higher preoperative hemoglobin concentrations and smaller hemoperitoneum volumes (P≤0.04 for both). CONCLUSION Women with PHAs at laparoscopy for EP had lower blood loss than did those without PHAs. The finding of PHAs was associated with an increased rate of recurrent EP, irrespective of a previous history of PID or EP.