A new approach to prevent cervical stenosis in postmenopausal women after loop electrosurgical excision procedure: a randomized controlled trial

Abstract

To determine whether regular cervical dilatation is effective for preventing cervical stenosis, and to identify the associated risk factors, in postmenopausal women after LEEP. This was a prospective randomized clinical trial in postmenopausal women who underwent Leep at our hospital between August 2018 and May 2019. Patients who met the study criteria were randomly allocated to three groups: control group (without any intervention), intervention group A (underwent cervical dilatation at the 3 rd , 5 th , and 8 th week after Leep) and intervention group B (underwent cervical dilatation at the 4 th , 8 th , and 12 th week after LEEP). A colposcopic follow-up examination was conducted at 6 months after LEEP to determine the incidence of cervical stenosis. A total of 404 postmenopausal women were found to be finally eligible for the study. The rate of cervical stenosis in the control group was significantly higher than that in the intervention group, and the rate in group A was significantly lower than that in group B. We found regular dilatation after LEEP in postmenopausal women can prevent cervical stenosis. Further, the 3rd, 5th, and 8th weeks after LEEP are optimal time points. Finally, LEEP frequency and resection depth are significant risk factors and can be used to screen postmenopausal women at risk for cervical stenosis after LEEP.

Mechanical dilatation of the stenosed cervix under local anesthesia: A prospective case series

“…The authors recommend regular rigid dilatation for the first 2 months post‐LLETZ to be conducted in the outpatient setting. 25 Although this approach did safely reduce cervical stenosis post‐LLETZ, offering all patients monthly rigid dilatation may not be practically feasible. This is especially the case as it is recommended that the procedure is performed by a senior clinician to maximize success rates and minimize risk of complications.…”

“…The prophylactic approach resulted in significantly few cases of cervical stenosis when compared to controls at 6 months, with no major complications. The authors recommend regular rigid dilatation for the first 2 months post‐LLETZ to be conducted in the outpatient setting 25 . Although this approach did safely reduce cervical stenosis post‐LLETZ, offering all patients monthly rigid dilatation may not be practically feasible.…”

Management of Cervical Stenosis - Mechanical Dilatation Adjunct with Hormonal Therapy

“…One of the risk factors of post-LEEP cervical was resection depth of more than 16.5mm in postmenopausal women [2]. History of LEEP was also a significant predictor of stenosis in younger group of patients (OR 1.32, 95% CI 1.1, 1.72; OR 17.4, 95% CI 2.7, 112; mean age 34) [6].…”

“…There was no consensus of the definition of cervical stenosis. It ranges from a physical examination finding, that there is cervical scarring with narrowing of cervical canal and/or complete obliteration of the external and internal cervical os [1], inability of passing cell brushes or instrument into cervical canal [2], to a functional problem, that leads to haematometra, retrograde flow of menstrual blood into the pelvis in premenopausal women, possibly endometriosis and pyometra in patients with cervical or uterine cancer [3]. Unsuccessful therapy can lead to hysterectomy [4].…”

LLETZ Procedure in an Outpatient Setting: Applicability and Cost-Effectiveness

“…In addition, according to the authors, plastic surgical treatment of stenosis led to re-stenosis in most cases. Lin et al off ered dilatation of the cervical canal at 3, 5, and 8 weeks following the LLETZ procedure to prevent cervical stenosis [15].…”