Comparison of Monopolar Electrosurgical Conization and the Loop Electrosurgical Excision Procedure in the Management of High-Grade Squamous Intraepithelial Lesion

Objectives: To compare the performance and outcomes of monopolar electrosurgical conization (MESC) or the loop electrosurgical excision procedure (LEEP) in the treatment of high-grade squamous intraepithelial lesion (HSIL).Methods: This retrospective study included 554 patients diagnosed with HSIL through biopsy. The study used either LEEP or MESC for cervical conization. Additionally, the medical records of these patients, including the basic information, status of the excision margin, cone depth, cone width, fragmentation, complication, and the results of a 6-month follow-up after conization, were reviewed.Results: Compared to MESC, LEEP had a significantly higher rate of positive endocervical margin (3.77 vs. 8.65%; p = 0.018), burn injury of the margin (4.90 vs. 10.38%; p = 0.016) and a lower rate of adequate cone depth (83.40 vs. 89.62%; p = 0.034). In addition, LEEP was significantly more likely to cause fragmentation (p = 0.000). There was, however, no significant difference in the rate of abnormal cervical cytology and positive high-risk HPV (hrHPV) between these two groups, 6 months after cervical conization.Conclusion: Both LEEP and MESC appeared to be equally effective in the clinical treatment of HSIL. Nonetheless, MESC resulted in a better pathological outcome with regard to the status of the margin, tissue fragmentation, and cone depth.

Pseudoaneurysm of the uterine artery post loop electrosurgical excision procedure

Background The formation of a uterine artery pseudoaneurysm is rare and isolated cases have been reported in the existing literature following caesarean sections, curettages and cone biopsies. There has been no report of pseudoaneurysm formation following a loop electrosurgical excision procedure. Vaginal bleeding could potentially be life threatening if this diagnosis is not considered following cervical instrumentation or surgery. Management options range from haemostatic sutures, image-guided embolisation to surgical repair. We report the diagnosis and management of a case of uterine artery pseudoaneurysm after a loop electrosurgical excision procedure. Case presentation A 37-year-old woman was diagnosed with cervical intraepithelial neoplasia grade 3 (CIN3) and underwent a therapeutic loop electrosurgical excision procedure. One month after the procedure, the patient presented to the emergency department with repeated episodes of sudden-onset heavy vaginal bleeding associated with hypotension and syncope. A computed tomography angiogram was performed, which demonstrated a pseudoaneurysm of the right uterine artery. Following the diagnosis, image-guided embolisation was performed successfully. Post-embolisation angiograms showed successful embolisation of the pseudoaneurysm and the patient had no further episodes of bleeding. Conclusions Loop electrosurgical excision procedures are generally safe but rarely, can be complicated by the formation of uterine artery pseudoaneurysms. The depth of the loop electrosurgical excision procedure and vascular anatomy should be considered to prevent such complications. A computed tomography angiogram appears to be ideal for diagnosis. Image-guided embolisation is safe and effective as a therapeutic measure, with minimal morbidity.

Estudio Descriptivo: Colposcopia en el diagnóstico de lesiones de cuello uterino en el Hospital de Especialidades José Carrasco Arteaga, Cuenca – Ecuador. 2015-2019

BACKGROUND: Cervical cancer is a public health issue, being one of the main causes of morbidity and mortality in developing countries. Cervical cytology (Papanicolaou) is performed for screening and diagnosis of cervical lesions. In case of a suspicious cytology report, colposcopy is an essential procedure for evaluation of the lower genital tract, to detect early lesions and cancer. The aim of this study was to characterize the colposcopy procedures performed, as a diagnostic and therapeutic method, in patients with abnormal Papanicolaou results. METHODS: This is an observational, descriptive cross-sectional study, whose universe were all the patients with abnormal cytological diagnosis in pap smear, who underwent a colposcopy procedure between 2015 and 2019 at Hospital José Carrasco Arteaga, with a total of 1 628 patients. RESULTS: 1 628 colposcopic procedures were included. 55.46% of the population were between 27 to 46 years of age. The predominant marital status was married status (75%). 63.45% of women had their first sexual experience between 21 and 30 years of age. 95.20% of the patients had between 1 and 3 sexual partners. Abnormal pap smear results represent; 37.28% to LSIL, followed by ASC-US (35.81%), and HSIL (14.18%). 67.32% of colposcopies were classified as satisfactory. Biopsy was performed in 71% of the patients, followed by loop electrosurgical excision procedure (LEEP) (13.69%), endocervical curettage in 11.05%. The pathology results reported HSIL in 46.56% of the cases, followed by 22.23% as LSIL and chronic cervicitis in 16.27%, 12.28% of the results were negative. CONCLUSION: Three-quarters of all colposcopies were performed on women between 27 and 56 years of age. The most frequently abnormal Pap smear results were: LSIL, followed ASC-US. 67% of the colposcopies were satisfactory. After colposcopy, biopsy was performed in most of the patients, in lower percentage: loop electrosurgical excision procedure (LEEP), endocervical curettage and diagnostic hysterectomy. Pathology results reported HSIL in 46.56%, LSIL IN 22.23% and chronic cervicitis in 16.27%; 12.28% of studies were negative.