Complications of outpatient LLETZ procedures

To determine the rates and types of acute complications occurring within 14 days of large loop excision of the transformation zone of the cervix.

A retrospective chart review was performed for patients who underwent a loop excision procedure between July 1999 and July 2001. Extracted information included age, parity, ethnicity, indication for the procedure, risk factors for cervical intraepithelial neoplasia, histologic classification of the specimen, and type and incidence of complications. Length of follow-up was also recorded. Statistical analysis was performed utilizing Wilcoxon sum analysis.

Five hundred fifty-seven charts were re- viewed; 74.8% of the patients were < or = 40 years old. Ethnicity was 59% Hispanic. The most common indication for loop excision was high grade squamous intraepithelial lesions on a Pap smear. Of the patients, 40% used tobacco, and 30% had a sexually transmitted disease. The overall complication rate was 9.7%, with a major complication rate of 0.6% and minor complication rate of 9.1%. Minor complications included 14 cases of abdominal pain and 26 of vaginal bleeding, 7 of which required treatment with Monsel solution or placement of Surgicel (Ethicon, Albuquerque, New Mexico). There were 6 cases of vaginal discharge and 1 of bladder spasm. Major complications included 1 patient with a bowel injury who returned to the operating room, 1 who returned to the operating room for hemorrhage and 1 with prolonged observation for chest pain. There was no association between age, parity, risk factors for cervical dysplasia, indication for procedure or pathology of specimen with acute complications.

Any surgical procedure may cause acute complications. While acute complications are not frequent with loop excision, the procedure is not entirely risk free.