Recurrent Dysplasia After a Loop Electrosurgical Excision Procedure: Local Versus General Anesthesia

Area of Science:

• Gynecology
• Surgical Oncology
• Colposcopy

Background:

• Loop electrosurgical excision procedures (LEEPs) are standard for treating cervical dysplasia.
• The choice of anesthesia, general anesthesia (GA) versus local anesthesia (LA), may influence outcomes.
• Comparing LEEP outcomes under GA and LA is crucial for clinical decision-making.

Purpose of the Study:

• To compare positive specimen margin rates after LEEP.
• To evaluate postconization recurrent dysplasia rates between GA and LA.
• To determine the optimal anesthesia choice for LEEP procedures.

Main Methods:

• Retrospective cohort study of women undergoing LEEP between 2011 and 2019.
• Exclusion criteria included prior conization, cold-knife conization, or loss to follow-up.
• Data collected: demographics, LEEP indication, cone dimensions, margin involvement, and recurrence rates.

Main Results:

• 71 women received GA-LEEP and 75 received LA-LEEP; groups were demographically similar.
• Positive endocervical margins: 22.5% (GA) vs 21.3% (LA), p=.861.
• Positive ectocervical margins: 19.7% (GA) vs 14.7% (LA), p=.418.
• Recurrent high-grade dysplasia within 2 years: 4.2% (GA) vs 1.3% (LA), p=.356.
• Need for repeat conization within 2 years: 7.0% (GA) vs 9.3% (LA), p=.614.

Conclusions:

• Anesthesia type (GA vs LA) does not significantly impact positive LEEP margins.
• Recurrent dysplasia rates and need for repeat conization are comparable between GA and LA.
• Local anesthesia is recommended for LEEP procedures due to comparable efficacy and potentially lower resource utilization.