Post-Loop Electrosurgical Excision Procedure Complications in Srinagarind Hospital

Hemostatic Efficacy of TachoSil in Loop Electrosurgical Excisional Procedure: A Prospective Randomized Controlled Study

OBJECTIVE

The aim of the study was to evaluate the hemostatic efficacy of the fibrin sealant patch (TachoSil) after loop electrosurgical excision (LEEP) and its influence on other complications and quality of life (QoL).

MATERIALS AND METHODS

This single-blind, prospective, randomized study involved patients undergoing LEEP with or without TachoSil (1:1) between August 2014 and August 2015 in Asan Medical Center, Korea. Primary outcome measures were bleeding duration and the frequency of additional treatment owing to vaginal bleeding within 2 weeks after LEEP. Secondary outcome measures were vaginal bleeding volume using pictorial blood loss assessment chart (PBAC) score, the amount of vaginal discharge, the frequency of external genitalia, vaginal, and cervical infections within 2 weeks after LEEP, and changes in QoL.

RESULTS

Of the 140 patients enrolled, 126 (90.0%) were successfully followed up and analyzed. The median vaginal bleeding duration and frequency of additional treatment owing to vaginal bleeding showed no significant difference in the TachoSil applied and nonapplied groups ( p = .96 and p = .61, respectively). In addition, no significant difference was also observed in vaginal bleeding volume between 2 groups ( p = .64). In subgroup analysis for patients who underwent large LEEP (the longest dimension of ≥2 cm), significant improvement was observed at physical functioning in QoL at 2-3 ( p = .03) and 6 weeks ( p = .03) after LEEP of the TachoSil applied group, compared to the nonapplied group.

CONCLUSIONS

TachoSil did not demonstrate significant hemostatic efficacy after LEEP. However, TachoSil improved patient recognition on physical function in patients who underwent large LEEP.

Efficacy of chitosan powder in reducing vaginal bleeding following a loop electrosurgical excision procedure: A randomized control trial

OBJECTIVE

To evaluate the efficacy of topical chitosan powder in reducing postoperative vaginal bleeding following a loop electrosurgical excision procedure (LEEP).

METHODS

In this randomized controlled trial, patients who underwent LEEP were randomly assigned (1:1) to the chitosan group, in which the wound area was sprayed with chitosan powder using a spray pump, or the control group. The primary outcome was the median quantity of vaginal blood lost in the early postoperative period (defined as within 6 h of the procedure).

RESULTS

The 124 women enrolled in the study were randomly divided into control (n = 61) and chitosan (n = 63) groups. The median amount of vaginal blood loss during the early postoperative period was significantly lower in the chitosan group than in the control group (198.85 [64.4-388.57] mL vs. 250.60 [67.7-552.87] mL; P < 0.001). The rate of late postoperative bleeding requiring hemostatic intervention was also lower in the chitosan group than in the control group (3.2% vs. 16.4%; P = 0.013). Superior cervical wound healing in the chitosan group compared to the control group was also observed.

CONCLUSION

The application of chitosan powder to the cervical wound bed can improve surgical outcomes by decreasing post-LEEP vaginal bleeding and facilitating the healing of cervical wounds.

Efficacy of a chitosan tampon in the loop electrosurgical excision procedure: A prospective randomized controlled study

It has been reported that chitosan has a hemostatic effect and an antibiotic activity. This study aimed to evaluate the efficacy and feasibility of using a chitosan tampon (Hemoblock-Tampon) in preventing hemorrhage and enhancing wound healing after the loop electrosurgical excision procedure (LEEP).This single-blind, prospective, randomized study included 62 consecutive patients who underwent LEEP for cervical intraepithelial neoplasia. A chitosan tampon (31 patients; treatment group), or a general tampon (31 patients; control group) was applied to the uterine cervix immediately after LEEP. One patient in the treatment group declined to participate in this study. Thus, 30 patients in the treatment group and 31 patients in the control group completed this study. For objective analysis of hemorrhage in the postoperative 2 weeks, the amounts of bleeding were checked daily with a pictorial blood assessment chart. We evaluated vaginal discharge, abdominal pain, and impairment in daily living during the postoperative 2 weeks using 5 visual analogue scale questionnaires.The bleeding count was significantly lower in the treatment group than in the control group (21.37 ± 16.86 vs. 40.52 ± 16.55, p = 0.0014). The sum of the scores of the 5 questionnaires was significantly lower in the treatment group than in the control group (6.53 ± 2.84 vs. 8.59 ± 2.88, p = 0.0079). The incidence of vaginal discharge was significantly lower in the treatment group than in the control group (20.0% vs. 48.4%, p = 0.0207). According to logistic regression, only the use of chitosan tampon reduced the risk of moderate to severe vaginal bleeding 2 weeks after surgery (Odd ratio, 0.213; 95% confidence interval, 0.06-0.76; p = 0.0172). Complete healing of the uterine cervix occurred in 86.7% of patients in the treatment group and in 61.3% of patients in the control group at 4 weeks after surgery (p = 0.0255).The use of chitosan tampons can reduce hemorrhage, vaginal discharge, abdominal pain, and impairment of daily living after LEEP. Moreover, chitosan tampon may help enhance wound healing.