Loop electrical excision procedure: Difference between revisions

Revision as of 14:41, 16 November 2023

Revision as of 15:16, 16 November 2023

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Complications are less frequent in comparison to a [[cervical conization|cold-knife conization]] but can include [[infection]] and [[hemorrhage]].<ref>{{Cite journal |last1=Jiang |first1=Yanming |last2=Chen |first2=Changxian |last3=Li |first3=Li |date=2017-01-26 |title=Comparison of Cold-Knife Conization versus Loop Electrosurgical Excision for Cervical Adenocarcinoma In Situ (ACIS): A Systematic Review and Meta-Analysis |journal=PLOS ONE |volume=12 |issue=1 |pages=e0170587 |doi=10.1371/journal.pone.0170587 |issn=1932-6203 |pmc=5268480 |pmid=28125627 |bibcode=2017PLoSO..1270587J |doi-access=free }}</ref>

A survey study did not find significant effects on [[fertility]].<ref>{{cite journal |vauthors=Turlington WT, Wright BD, Powell JL |title=Impact of the loop electrosurgical excision procedure on future fertility |journal=J Reprod Med |volume=41 |issue=11 |pages=815–8 |date=November 1996 |pmid=8951130 }}</ref> However, a [[case-control study]] found an association between surgical treatment of CIN lesions and risk of [[femalesubfertility infertility|infertility]]defined oras subfertilityprolonged time to conception, with an odds ratio of approximately 2.<ref>{{Cite journal | last1 = Spracklen | first1 = C. N. | last2 = Harland | first2 = K. K. | last3 = Stegmann | first3 = B. J. | last4 = Saftlas | first4 = A. F. | title = Cervical surgery for cervical intraepithelial neoplasia and prolonged time to conception of a live birth: A case-control study | doi = 10.1111/1471-0528.12209 | journal = BJOG: An International Journal of Obstetrics & Gynaecology | volume = 120 | issue = 8 | pages = 960–965 | year = 2013 | pmid = 23489374 | pmc =3691952 }}</ref> Scarring of the cervix is a theoretical mechanism of causing trouble conceiving. This scar tissue can be massaged or broken up in a number of ways, thus allowing the cervical opening to dilate back to normal size.

A [[cohort study]] concluded that women with a time interval from LEEP to pregnancy of less than 12 months, compared with 12 months or more, were at significantly increased risk for [[miscarriage]], with risk of miscarriage of 18% compared with 4.6%, respectively, suggesting that increasing latency times from treatment to pregnancy initiation improves outcomes.<ref name=Chescheir2013>{{Cite journal | last1 = Conner | first1 = S. N. | last2 = Cahill | first2 = A. G. | last3 = Tuuli | first3 = M. G. | last4 = Stamilio | first4 = D. M. | last5 = Odibo | first5 = A. O. | last6 = Roehl | first6 = K. A. | last7 = MacOnes | first7 = G. A. | doi = 10.1097/01.AOG.0000435454.31850.79 | title = Interval from Loop Electrosurgical Excision Procedure to Pregnancy and Pregnancy Outcomes | journal = Obstetrics & Gynecology | volume = 122 | issue = 6 | pages = 1154–9 | year = 2013 | pmid = 24201682| pmc = 3908542}}</ref> A large [[meta-analysis]] concluded that women with CIN have a higher baseline risk for preterm birth than the general population and that LEEP as the treatment for CIN could increase this risk further. The risk of preterm birth appears to increase with multiple treatments and increasing amounts of tissue removed.<ref name="pmid29095502">{{cite journal | vauthors = Kyrgiou M, Athanasiou A, Kalliala IE, Paraskevaidi M, Mitra A, Martin-Hirsch PP, Arbyn M, Bennett P, Paraskevaidis E | title = Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 11 | pages = CD012847 | date = November 2017 | pmid = 29095502 | pmc = 6486192 | doi = 10.1002/14651858.CD012847 }}</ref>

A study found that women reported a statistically significant decrease in sexual satisfaction following LEEP.<ref name=":0">{{cite journal|title=Sexual function after loop electrosurgical excision procedure for cervical dysplasia|first1=Namfon|last1=Inna|first2=Yupin|last2=Phianmongkhol|first3=Kittipat|last3=Charoenkwan|date=1 March 2010|journal=J Sex Med|volume=7|issue=3|pages=1291–1297|doi=10.1111/j.1743-6109.2009.01633.x|pmid=19968775}}</ref> Though dyspareunia and dysmenorrhea were reported as not statistically significant, there may be more subjective and specific patient sexual outcomes which explain this decrease in satisfaction.

A [[systematic review]] and meta-analysis published in 2014 which sought to examine the differences in preterm labor risk between patients who had a LEEP procedure and those who had CIN findings concluded that there is not a significant difference between those groups in terms of risk, as might previously have been suggested. The study determined that both groups have a higher likelihood for preterm labor than healthy controls, but suggests that a LEEP procedure in a CIN patient might not carry as significant of an increase in risk for preterm labor in future pregnancies as is generally understood.<ref name="pmid24785601">{{cite journal | vauthors = Conner SN, Frey HA, Cahill AG, Macones GA, Colditz GA, Tuuli MG | title = Loop electrosurgical excision procedure and risk of preterm birth: a systematic review and meta-analysis | journal = Obstetrics and Gynecology | volume = 123 | issue = 4 | pages = 752–61 | date = April 2014 | pmid = 24785601 | pmc = 4113318 | doi = 10.1097/AOG.0000000000000174 }}</ref> This perspective carries significant implications when it comes to pregnancy timing and decision making in women of child bearing age who have cervical dysplasia and would like to decide whether they should have the lesions removed before or after pregnancy. As pregnancy is generally understood to be an immune suppressed state, the viral mediated character of cervical lesions might also inform revisions to treatment recommendations in such instances.<ref name="pmid24785601"/>