LOOP DIATHERMIA

LOOP conization

LOOP conization or LLETZ (large loop excision transformation zone) is a very important, fast and very often life-saving outpatient surgery that is performed under local or short-term general anesthesia, without catheters or sutures, with a very easy and quick recovery, where the patient goes home with minimal pain immediately 30 minutes after the intervention, while classic conization requires a shorter hospitalization.

Classic conization can permanently damage and deform the cervix and its canal. It can lead to: painful menstruation, difficulty getting pregnant, complications during pregnancy and childbirth, difficulty in passing menstrual blood (hematometra), and fluid accumulation in the uterus in postmenopause or senility.

It is estimated that more than 50% of sexually active women will be infected with some type of HPV or multiple types of HPV during their lifetime. In a certain number of cases, the virus will clear completely without any symptoms, but there is also the possibility of symptoms and an increased risk of developing cervical cancer.

The main cause of about 92% of cervical cancers is HPV (Human Papilloma Virus). The predominant HPV types causing malignancy are: 16, 18, 31, 33, 35, 39, 45, 52, 58, 59, 66, 68, 69, 73, 82, 83.

The introduction of mandatory colposcopic screening for cervical cancer (Pap test) and education of the population has significantly reduced the incidence of invasive stages of cancer that require complex treatment and major surgical procedures combined with radiation and chemotherapy.

Early entry into unprotected sexual relations and irresponsible sexual behavior shifted the distribution of cervical cancer towards younger age groups, so it is not uncommon for cancer to appear already at the age of 25 to 30 years and premalignant changes (CIN1, CIN2, CIN3, L-SIL, H-SIL, ASCUS, AGUS) at the age of 18 to 25 years.

Given that HPV – Human Papilloma Virus has been proven to be the main cause of cervical cancer in women, that its presence is very widespread in the population of sexually active women, and that its transmission is very difficult to control, it is important to detect it in time and begin treatment.

Classic conization or Loop

Although it is often performed in our country, in modern medicine, classic conization with a surgical knife is being abandoned. Minimally invasive surgical techniques are in trend, where complete healing occurs with minimal tissue damage and the patient is exposed to far less stress, with an extremely fast recovery and full return to work.

Just as gynecological endoscopic surgery (laparoscopy and hysteroscopy) has replaced certain classical surgical methods, LOOP has replaced classical conization.

In modern gynecology, LOOP or LLETZ surgery on the cervix is ​​the most modern method of surgical treatment of cervical dysplasia (CIN 1, CIN2 and CIN 3) from which cancer develops. This method of treating cervical dysplasia has almost completely replaced the classic conization with a surgical knife, which is reserved only for in situ carcinoma (“stage zero carcinoma”).

Three to six months after LOOP surgery, the cervix is ​​completely restored without any scarring and it is difficult to even assume that any surgery was performed on the cervix. On the other hand, classic conization with a surgical knife always leaves a shortened, less valuable and scarred cervix, regardless of the surgical technique used.

A particular complication of classic conization with a surgical knife is narrowing (stenosis) or complete closure (obliteration) of the cervical canal. This can cause serious problems because menstrual blood has difficulty draining, causing severe pain, or does not drain at all, remaining in the uterine cavity (hematometra) or flowing back through the fallopian tubes (hematosalpinx) into the abdominal cavity (hematoperitoneum).

This complication can occur 10 or more years after classic conization – in postmenopause or senility, when fluid accumulates in the uterus (serometra) because it cannot drain through the closed cervical canal. This can then create diagnostic difficulties because serometra can be associated with uterine cancer.

Advantages of loop compared to classic conization

It is far less invasive, it “spares” the cervix and its canal more – after the intervention, the cervix fully returns to its function.

The internal cervical os remains “competent” i.e. firm, fulfilling the role of the “closing mechanism” of the internal cervical os during pregnancy – so this surgery does not compromise the desired pregnancy and is especially recommended for young women who have not yet achieved the desired offspring.

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