Laparoscopic Management of Early Primary Abdominal Ectopic Pregnancy: A Retrospective Case Series With an Organ-Preserving Approach.

INTRODUCTION: Early primary abdominal ectopic pregnancy (EAP) is a rare but potentially life-threatening condition. Preoperative diagnosis is often difficult, and optimal management remains undefined, particularly when the gestational mass is adjacent to vital structures and complete surgical excision carries a risk of organ injury. METHODS: We retrospectively reviewed surgically and pathologically confirmed ectopic pregnancies managed at Kobe City Medical Center General Hospital, a tertiary referral hospital in Kobe, Japan, from January 2015 to December 2025, to identify EAP cases. Diagnosis was based on intraoperative findings and histopathological confirmation of chorionic villi. Clinical characteristics, surgical outcomes, and perioperative serum human chorionic gonadotropin (hCG) trends were analyzed. RESULTS: Seven cases of EAP were identified among 208 surgically and pathologically confirmed ectopic pregnancies. The mean gestational age at diagnosis was six weeks and one day. Implantation sites were as follows: sigmoid mesocolon (n = 1), pouch of Douglas (n = 3), vesicouterine pouch (n = 1), and posterior uterine wall (n = 2). The mean operative time was 97 minutes, and the mean estimated intraoperative blood loss was 414 mL. All seven cases were managed laparoscopically without major perioperative complications. During laparoscopic surgery, gestational tissue was removed as completely as is safely possible, but intentional conservative excision was performed near the sigmoid mesocolon or bladder to avoid organ injury. Adjunctive methotrexate (MTX) was administered in the sigmoid mesocolon case based on postoperative hCG trends, resulting in complete resolution. CONCLUSION: In this small series of early EAP cases, laparoscopic diagnosis and treatment were achieved following timely operative assessment without conversion to laparotomy or major complications. When complete excision poses a risk of organ injury, a stepwise, organ-preserving approach comprising maximal safe excision, postoperative hCG surveillance, and selective MTX may help achieve clinical resolution.