Routine prophylactic application of Monsel's solution after loop electrosurgical excision procedure of the cervix: Is it necessary?
ABSTRACT To determine the benefit of an immediate application of Monsel's solution after loop electrosurgical excision procedure (LEEP) of the cervix for preventing postoperative bleeding.
This randomized controlled trial was conducted at Chiang Mai University Hospital, Chang Mai, Thailand. Women who were scheduled for LEEP were approached for participation in the study. The primary endpoint was the duration of uncomplicated vaginal bleeding. Secondary endpoints were the incidence of persistent vaginal bleeding, and postoperative complications including severe early bleeding, severe delayed bleeding and infection.
Between October 2004 and May 2006, 285 women with an abnormal Pap-smear, who had undergone LEEP, were randomly allocated to the Monsel's group (n = 140) or control group (n = 145). The baseline outcomes were similar between the two groups. In the Monsel's group, the duration of uncomplicated vaginal bleeding was significantly shorter (P < 0.001) and the occurrence of persistent vaginal bleeding was significantly lower (P = 0.014) than in the control group. The occurrence of severe complications that required treatment, including bleeding and infection, was not significantly different between the two groups (P = 0.379).
An application of Monsel's solution after LEEP appears to reduce the duration of postoperative vaginal bleeding, but does not significantly prevent severe complications. Such practice may not be necessary if adequate hemostasis is achieved using electrical cauterization.
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ABSTRACT: This study was conducted to evaluate the incidence and predictor of perioperative complications of the loop electrosurgical excision procedure (LEEP) in an outpatient setting at Chiang Mai University Hospital between October 2004 and December 2008. During this time period, 857 women were reviewed. Mean age was 45.1 years (range, 20-78 years). One-fourth of the women were postmenopausal. Eighty-one (9.5%) women were HIV positive. Perioperative complications were as follows: intraoperative bleeding, 29 (3.4%); early postoperative bleeding, 5 (0.6%); late postoperative bleeding, 42 (4.9%); and infection 37 (4.3%). The size of LEEP specimens was noted to be a significant predictor. Women who had a large LEEP specimen excised (defined as 20 mm or more) were 2.09 (95% Confidence Interval, 1.39-3.14) times more likely to have perioperative complications. In conclusion, outpatient LEEP is safe and has an acceptable perioperative complication rate, although large size carries greater risk.Asian Pacific journal of cancer prevention: APJCP 10(3):351-4. · 1.50 Impact Factor
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ABSTRACT: We examined the association of fibrin sealant use with post-operative hemorrhage in patients who underwent a loop electrosurgical excision procedure (LEEP). We retrospectively collected clinicopathologic data of 344 patients who underwent LEEP at our institute between 2007 and 2009. We defined hemorrhage which occurred between 1 and 30 days after LEEP and required electrocautery to achieve hemostasis as severe secondary hemorrhage (SSH). We determined whether or not the use of fibrin sealant during LEEP was associated with a decreased occurrence of SSH. In addition, we examined the associations of other clinicopathologic variables with SSH and fibrin sealant use. SSH occurred in 6 of 200 patients (3%) with fibrin sealant and in 12 of 144 patients (8%) without fibrin sealant. Based on univariate analysis, the use of fibrin sealant was associated with SSH (p = 0.028). However, age, surgeons and pathologic diagnosis were not associated with SSH. Based on multivariate analysis, the use of fibrin sealant was associated with less SSH (p = 0.033, OR = 0.328, 95% CI 0.117-0.917). Fibrin sealant use reduces the incidence of severe post-operative hemorrhage after LEEP.Gynecologic and Obstetric Investigation 06/2012; 74(1):1-5. DOI:10.1159/000333266 · 1.25 Impact Factor
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ABSTRACT: To compare the complications and success rate of Contour-Loop Excision of the Transformation Zone (C-LETZ) with Cold Knife Conization (CKC) in High Grade Lesion (HGL). Between April 1st, 2007 and November 30th, 2007, forty-five C-LETZs were performed in patients who had Pap smear result of High grade Squamous Intraepithelial Lesion (HSIL) or Squamous Cell Carcinoma (SCC) combined with colposcopic impression of satisfactory HGL by using the "See and Treat" approach. Success rate, tissue size, operating time, blood loss, intra-operative, and post-operative complications (2 weeks) were recorded to compare with the retrospective results from therapeutic CKC. Forty-five cases of C-LETZ and 50 cases of CKC were compared. Using the "See and Treat" approach, the over-treatment rate was 6.7% (3/45). The success rate and tissue size were not different between both groups. The operating time, blood loss, and post-operative infection were significantly less in the C-LETZ group. The authors compared CKC with C-LETZ, which is a new method for the management ofHGL of the cervix and found C-LETZ to be a favorable method with comparable efficacy but with significantly less morbidity, and suitable as a "See and Treat" method in a hospital outpatient clinic.Journal of the Medical Association of Thailand = Chotmaihet thangphaet 12/2009; 92(12):1573-9.