Inovative Surgical Treatment for Intratubal Administration of Methotrexate

Abstract

In patients where conservative medical treatment with methotrexate failed, surgical intervention was necessary. The personal surgical method was performed on a number of 9 patients; the surgical intervention was a conservative method – salpingorraphy. In order to prevent persistent gestational throphoblastic disease and tubal clogging, a polyethylene catheter is introduced in the oviduct until it reaches the ostium of the Fallopian tube, without exceeding it. In order to ensure a rigorous haemostasis, the Fallopian tube and the polyethylene catheter are sutured together. The level of HCG is measured in the fourth and seventh day postoperative: if the levels of HCG are higher than 1000 mUI/ml, if they plateau or if they have increased, methotrexate is administered intraluminally through the polyethylene tube, according to the following scheme: 50 mg of methotrexate are dissolved in 10 ml of physiological saline solution and injected through the polyethylene catheter, for 5 days. 10 mg per day in 2 doses (5 mg in the morning and 5 mg in the evening).If the values of HCG decrease to an adequate level and there is no risk of persistent throphoblastic disease, the polyethylene catheter is kept for 8-12 days, afterwards it is extracted by traction. If the values do not decrease accordingly, the intraluminal administration of methotrexate is resumed after a 3-day break. This method was used on a number of 9 patients; 4 of them had been treated with methotrexate before the surgical intervention and pertain to the study, and 5 of them had been operated on for complications of ectopic pregnancy and were suitable for this kind of surgical intervention. No postoperative complications or deaths were recorded.