Complications of outpatient LLETZ procedures

OBJECTIVE: To determine the rates and types of acute complications occurring within 14 days of large loop excision of the transformation zone of the cervix. STUDY DESIGN: 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)or 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. RESULTS: Five hundred fifty-seven charts were reviewed; 74.8% of the patients were less than or equal to 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 I patient with a bowel injury who returned to the operating room, I who returned to the operating room for hemorrhage and I 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. CONCLUSION: Any surgical procedure may cause acute complications. While acute complications are not frequent with loop excision, the procedure is not entirely risk free.