[Consequences and treatment of cervical stenoses after laser conization or loop electrosurgical excision].
OBJECTIVE
To assess the frequency and the consequences of cervical stenosis in patients treated by laser conization or loop electrosurgical excision procedure (LEEP) and to analyse the results of cervical enlargement plastic surgery or neostomia.


METHODS
Two hundred and fifty-five women treated by laser conization and 277 by LEEP were regularly followed by postoperative colposcopy, for a mean period of 38 and 16 months, respectively. Stenosis was defined as cervical narrowing which could not admit a 2.5 mm-diameter Hegar's dilator.


RESULTS
Stenosis complicated 10.2% of the laser conizations and 4.3% of the LEEP. Thus, 38 cases of cervical stenosis of which 7 were complete were diagnosed 2 to 40 months after treatment. Among the 34 non-menopaused women who developed a stenosis, 5 had a secondary amenorrhea, 6 a severe dysmenorrhea and one an infertility related to oligoamucorrhea. In the patients with stenosis, endocervical cell retrieval was possible in 21 (55%) cases and in none the squamocolumnar junction was visible at colposcopy. Seven patients underwent an enlargement plastic surgery of the cervical canal for incomplete stenosis and two a neostomia for complete stenosis. Cervical restenosis has been observed in 7 of 9 cases in a mean delay of 12 months (3 to 48 months). Nevertheless, the endocervical cell retrieval remained possible in 8 of 9 cases and after a mean follow-up of 26 months no menstrual troubles recurred.


CONCLUSIONS
LEEP provides fewer cervical stenosis than laser conization. The enlargement plastic surgery allows to correct durably the menstrual troubles in spite of the very frequent restenosis.
Baldauf
J J
JJ
Service de Gynécologie Obstétrique I, Hôpital de Hautepierre, Hôpitaux Universitaires, Strasbourg.
Dreyfus
M
M
Wertz
J P
JP
Cuénin
C
C
Ritter
J
J
Philippe
E
E
D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D019092:Conization / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D004598:Electrosurgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D012189:Retrospective Studies; D002578:Uterine Cervical Dysplasia / Q000601:surgery*
Conséquences et traitement des sténoses cervicales survenues aprés une conisation au laser ou une résection à l'anse diathermique.