Cervical stenosis following electrosurgical conization
Keywords:
Electrosurgery, Cervical intraepithelial neoplasia, Postoperative complications, Conization, Constriction, pathologicAbstract
CONTEXT AND OBJECTIVE: Cervical stenosis is a postoperative complication of procedures for treating preinvasive lesions of the cervix and takes on particular importance due to the clinical repercussions associated with it. Furthermore, it causes limitations in relation to cytological and colposcopic follow-up. The aim here was to assess the incidence of cervical stenosis among a cohort of patients who underwent electrosurgical conization and to identify possible prognostic factors associated with its occurrence. DESIGN AND SETTING: Retrospective study at Gynecology and Obstetrics Department, Instituto Fernandes Figueira, Rio de Janeiro. METHODS: This was an observational study among a cohort of patients who underwent electrosurgical conization of the uterine cervix. The possible predictive variables were analyzed as bivariate means between the groups with and without stenosis. We also calculated the incidence density rate ratio for cervical stenosis in relation to each possible predictive variable and the respective confi dence intervals (95%). Levels of 5% were considered signifi cant. RESULTS: 274 patients who underwent electrosurgical conization of the uterine cervix with a minimum follow-up period of six months were included. The crude incidence of cervical stenosis was 7.66% and the incidence density was 3.3/1,000 patients-month. CONCLUSIONS: We did not fi nd associations between the variables for stenosis. However, we observed borderline signifi cance levels relating to hemorrhagic complications before and after the operation (p = 0.089).
Downloads
References
Suh-Burgmann EJ, Whall-Strojwas D, Chang Y, Hundley D, Goodman A. Risk factors for cervical stenosis after loop electrocautery excision procedure. Obstet Gynecol. 2000;96(5 Pt 1):657-60.
Kim YT, Kim JW, Kim DK, Song CH. Loop diathermy and cold-knife conization in patients with cervical intraepi- thelial neoplasia: a comparative study. J Korean Med Sci. 1995;10(4):281-6.
Diakomanolis E, Haidopoulos D, Radolakis A, et al. Treating intraepithelial lesions of the uterine cervix by laser CO2. Evalua- tion of the past, appraisal for the future. Eur J Gynaecol Oncol. 2002;23(5):463-8.
Wright TC, Richart RM, Ferenczy A. Electrosurgery for HPV- related diseases of the lower. Genital tract. A practical handbook for diagnosis and treatment by loop electrosurgical excision and fulguration procedures. New York/Quebec: Arthur Vision, Incorporated and BioVision, Incorporated; 1992.
Luesley DM, McCrum A, Terry PB, et al. Complications of cone biopsy related to the dimensions of the cone and the influence of prior colposcopic assessment. Br J Obstet Gynaecol. 1985;92(2):158-64.
Newman C, Finan MA. Hysterectomy in women with cervical stenosis. Surgical indications and pathology. J Reprod Med. 2003;48(9):672-6.
Penna C, Fambrini M, Fallani MG, Pieralli A, Scarselli G, Marchionni M. Laser CO2 conization in postmenopausal age: risk of cervical stenosis and unsatisfactory follow-up. Gynecol Oncol. 2005;96(3):771-5.
Mathevet P, Chemali E, Roy M, Dargent D. Long-term outcome of a randomized study comparing three techniques of conization: cold knife, laser, and LEEP. Eur J Obstet Gynecol Reprod Biol. 2003;106(2):214-8.
Houlard S, Perrotin F, Fourquet F, Marret H, Lansac J, Body
G. Risk factors for cervical stenosis after laser cone biopsy. Eur J Obstet Gynecol Reprod Biol. 2002;104(2):144-7.
Baldauf JJ, Dreyfus M, Ritter J, Meyer P, Philippe E. Risk of cervical stenosis after large loop excision or laser conization. Obstet Gynecol. 1996;88(6):933-8.
Prendiville W. Large loop excision of the transformation zone. In: Prendiville W, editor. Large loop excision of the transformation zone. A practical guide to LLETZ. London: Chapman & Hall Medical; 1993. p. 35-58.
Ferris DG, Hainer BL, Pfenninger JL, Zuber TJ, DeWitt DE, Line RL. Electrosurgical loop excision of the cervical transfor- mation zone: the experience of family physicians. J Fam Pract. 1995;41(4):337-44.
Brun JL, Youbi A, Hocké C. Complications, séquelles et devenir du col traité par conisation: évaluation à travers 3 techniques opératoires. [Complications, sequellae and outcome of cervical conizations: evaluation of three surgical technics]. J Gynecol Obstet Biol Reprod (Paris). 2002;31(6):558-64.
