Burns are always a possibility when working with electric current. Burns in the vaginal vault are usually due to poor visualization or operator inexperience. There is also a risk of burns via alternate grounding sites or under the pad due to poor return electrode contact. Most of the last two types have been eliminated with modern return electrode monitoring that cuts off the current to the loop if normal grounding is disrupted.
LEEP complication rates are shown in Table 5. When excising the transformation zone with the LEEP procedure, perioperative bleeding is rare, especially with the use of fulguration and Monsel's solution. 1, 2, 5, 8, 11, 22, 31, 32 It is significantly less than with laser therapy. 5 Significant late bleeding has also been reported in 0 to 14 percent of patients who had LEEP therapy. 1, 2, 6, 8, 11, 12, 22, 24, 31 - 34 Most did not require hospitalization and were treated with vaginal packing or suturing. This compares well with bleeding rates for laser therapy, which range from 1.5 to 11 percent, 5, 32 35 and for cryotherapy, which are usually less than 1 percent. 14 Infection also has been reported in 0 to 8 percent of patients. 2, 11, 12, 24, 32
Incomplete removal of the lesion when excising the transformation zone is another potential risk. Positive margins have been reported in up to 15 percent of patients. 12, 24 There are some data that suggest the recurrence rate in patients with positive margins is low (around 25 percent), possibly due to the fulguration of the bed after excision. 12, 24
A less common complication found in larger studies was cervical stenosis (0.5 to 4 percent of cases). 1, 11, 31, 33 This was found mainly in patients with deep removal of extensive lesions, 1, 27 and may be as high as 19 percent in LEEP conization. The risk of incompetent cervix and sterility are included in informed consent by some practitioners for theoretical reasons, but there are no published clinical data to support this. Most experts feel cold knife conization is preferable to LEEP in known microinvasive or invasive disease. LEEP is contraindicated in invasive disease, and its safety in pregnancy has not been established.
LEEP conization has been found to have a higher complication rate than
LEEP excision of the transformation zone (Table 5). Perioperative bleeding
has been observed in 0 to 5 percent of patients. 8, 22, 24 Late bleeding
has been reported in 0 to 14 percent of patients treated with LEEP conization.
8, 22, 24 This correlates with early LEEP studies that showed higher bleeding
rates with deeper excisions. 1
Table 5. LEEP complication rates from the English language literature. Ref # in Immediate Late Cervical Poor TZ Infection Follow-up Study Bleeding Bleeding Stenosis Appearance Time ---------------------------------------------------------------------------- 1 616 8.5% 4.3% 1.3% - - 6 months 2 111 1.8% 1.8% - - 8.1% 1 year 5 98 0 - - - - 6 months 6 1000 - 0.6% - - - 4 months 8 52 0% 1.9% - 7.7% - 6 months 11 198 6.8% 0.5% 0.5% 19% 6.4% 1 year 12 127 - 7% - - 1.6% 3 months 31 236 2.5% 4.5% 3.6% 23.8% - 4-6 months 32 185 1.1% 11.1% - - 0 6 months 33 424 - 8% 4% - - 4.7 years 34 1000 - 0.06% - - - 8 months 46 141 0 2.8% - - - - 47 1070 1% 2.4% 1.2% - 0.7% 19 months 8** 14 0% 14% - 23.1% - 6 months 22** 36 5% 5% 19% 19% - 6 months 24** 50 0.5% 1.5% - - 1.5% 1 month*Defined as moderate to severe bleeding with or without need for sutures, packing, etc.
** LEEP-cone procedures.
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