Conization of the cervix to eliminate precancerous conditions: should you agree to the procedure or not? Radio wave conization as a method of treating the cervix Bleeding after conization.
Review - Anna
2017-06-03 13:45:13I have a very pleasant impression from the clinic itself and from the clinic staff. Many thanks to the manager. Anistratenko Sergei Ivanovich, who performed the operation on me to remove fibroids, for his professional advice and the successfully performed operation. This man has “golden hands”, I would like to wish him good health, happiness and all the best. In general, we can only say good things about this clinic: the service, quality and conditions are at the highest level, despite the fact that the clinic is young. The staff is polite, the food is very tasty, the clinic itself is clean and tidy. Many thanks to all employees! I only wish further professional growth and development for the employees and the clinic to remain at the same level!
Review - Elena
2017-07-24 13:40:15When entering the Clinic, I felt only fear. Having met the doctors and nurses, I calmed down and realized that everyone wanted to do the best for me. In a word. It was like being at a resort, the attitude was excellent; if God forbid... I will only contact the “Good Prognosis” clinic. I’m happy with everything. I don’t know how to speak, I write as I feel. Health to everyone!!!
Review - Elena
2017-07-27 13:36:12I am very grateful for the attention of the nurses and nursing staff to the patients, the food was very tasty and high quality, the whole team was very friendly, I am immensely grateful to everyone. Thank you! I wish you good health, good health and prosperity to you all.
Review - Tamara
2017-06-02 13:23:07I am Tamara Yosifovna, a resident of Zaporozhye, who underwent surgery to correct urinary incontinence at the Good Forecast clinic. And I express my deep gratitude to the entire team that works in this clinic - for extensive consultation, for excellent moral support, for a comprehensive and in-depth examination of all doctors, and especially the ultrasound doctor Vladimir Ivanovich Ryzhov... For the trouble-free, competent and impeccable provision of medical care... All employees , the “Good Forecast” clinics are very attentive, scrupulous, friendly, and also responsible to all patients who come to them with their problems... I would especially like to note the high professionalism and competent approach to my work of my leading surgeon Sergei Ivanovich Anistratenko; as well as Volkov Vladislav Vladimirovich - an irreplaceable anesthesiologist and psychologist - in the second person and resuscitation nurse Victoria Maletskaya. Thank you very much for your golden hands, bright head, kind angelic heart and integral professional work. I bow to you for being in the world and immaculately helping others. All conditions at the clinic are excellent. The food is excellent - there is no comparison with any wide-profile restaurant, the food at the clinic is homemade - very tasty, refined and varied... And the comfort and cleanliness are like in EDEM... Thanks to all the nurses - for your kindness, attention, scrupulousness and responsibility - a deep bow to you... And so Many thanks to the technical staff - for the ideal cleanliness, home comfort, order, maternal attention and warmth of soul. I would also like to thank all the girls working at the reception, the administrator Roskina Alena and Berezanets Marinka - for the quick, deeply detailed consultation, for the respect and kindness towards visitors. I would also like to note and thank the guards: Alexandra Evstafiev and Alexandra Slobodyanyk - for their vigilance, hard work, respect for everyone and professionalism. Thank you to the management, administration and all the organizers who created this bright corner of paradise called: the “Good Forecast” clinic. My wish is that your professionalism meets no obstacles, that your love for your very necessary profession and great patience for the sick never fades away. And we, who turned to you, always left healthy, happy and with warmth in our souls. I wish you further prosperity, all-round love and respect. Peace and goodness to everyone and unlimited professional development.
Review - Anna
2017-08-23 13:19:19The clinic has the highest level of care, which meets European standards. Create a series of clinics throughout Ukraine.
Review - Tatiana
2017-07-24 13:15:23High level clinic: Amazing staff. Wonderful doctors! Tasty food. Cleanliness of rooms and bed linen.
Review - Inna
2017-08-16 12:56:49Thank you very much for the attentive, sensitive attitude of the medical staff. I had no idea that there were still clinics with such an attitude. The atmosphere is welcoming and open. Of course, I will recommend your clinic to all my friends and relatives. Special thanks to the excellent doctor, a professional in her field, Anna Alexandrovna Averina. Health to you, A.A., good luck and success! Prosperity to your clinic.
Review - Galina
2017-09-13 12:49:15The enemies themselves are kind, they are the most positive. Irina Volodymyrivna is a doctor like God, please encourage me first, explain correctly. I'm glad that I took my problem to this clinic myself. Health to everyone who works in this clinic. As of now, you are already the best! Don't ruin what you deserve!
Review - Oksana
2017-10-08 12:39:13Our deepest hearts go out to the doctor and to all the staff at the clinic. All services were given at the highest level. I wish everyone good health and well. Be patient, don’t give up no matter the difficulties.
Review - Inna
2017-10-03 12:36:42With all my heart I want to express my deep gratitude to all the staff of the Good Forecast clinic. I especially want to say thanks to my attending physician Valery Aleksandrovich Zabolotin, who performed a very complex operation, while saving my uterus, family, and future. I would like to thank the anesthesiologist Yulia Grigorievna, I felt great after general anesthesia, thanks to the nurses who monitored my condition (thanks to nurse Vika, who found an individual approach to each patient. Professionalism, trust in the doctor, understanding, positivity, quality treatment are very important to me I received all this at the “Good Forecast” clinic. I would like to give birth to you in the future
Conization of the cervix is the removal of part of the cervix and is an effective way to diagnose and treat many pathologies of the reproductive system. The procedure can be performed in various ways depending on age, indications, and desire to have children.
The most gentle and popular are electroconization and radio wave conization. Cryodestruction is extremely rarely prescribed. Knife conization is currently used for cancer lesions.
The procedure can be performed either on an outpatient basis or in a hospital setting, under local or general anesthesia, depending on the chosen intervention option. After conization, certain restrictions must be observed. The rehabilitation period ranges from one to several months. After conization, it is possible to have children if you choose the appropriate surgical technique. The cost of the procedure starts from 2500 rubles and increases depending on the type of intervention.
Read in this article
What is conization of the cervix, its types
Conization is a surgical procedure during which part of the cervix is removed for therapeutic or diagnostic purposes. This operation is aimed at removing a section of mucous membrane with a “cone”, hence the name – conization.
Resection is subject to altered tissue of the cervix up to the cervical canal, which is subsequently sent for cytology. An area 5-7 millimeters thick at the border with healthy tissue is captured in order to then determine the extent and depth of the lesion. That is, the cone includes the vaginal part of the cervix, partially the cervical canal and all the changed tissues with the transformation zone.
If during the study dystrophic changes were identified, then the operation is considered curative, and if atypical cells are found, then this indicates a malignant process, which means that conization was diagnostic, and radical surgery on the genital organs is required.
Conization has made it possible to treat and diagnose many processes in the cervical area; various methods have now been developed for removing tissue in the genital organs. The choice of method is based on various parameters: the woman’s age, expected diagnosis, desire to have children in the future, body condition and the presence of contraindications. There are several main types of procedure.
| Type of operation | Main application, characteristics |
|
Knife or surgical conization |
For the diagnosis of malignant neoplasms, the option is painful and leaves scars |
| Laser conization | Almost painless option, but requires precision, very low risk of bleeding and inflammation in the postoperative period |
| Diathermoelectroconization | The most painless method, possible under local anesthesia, very accurate method, depth from 5 to 8 millimeters |
| Cryoconization | It also damages healthy tissues, there is no way to examine the obtained material, only a therapeutic procedure, rarely used |
| Radio wave removal | Electromagnetic waves accurately act on the pathological focus, can be used in nulliparous women, low risk of complications |
| Electroconization | Electrical excision is used mainly for collecting material and removing malignant tumors; there is a risk of bleeding after surgery |
| Loop electroexcision | Removal of soft tissue using electric current and sampling loop, low risk of further scarring, used for both therapeutic and diagnostic purposes |
Depending on the volume of tissue removed, the following are distinguished:
- superficial - only a small layer of tissue is removed;
- low – removal at the level of the lower third of the cervical canal;
- average – at level 2/3;
- high – almost the entire cervix is resected.
When is it appointed?
Conization of the cervix is prescribed both for treatment by removing the altered area, and for diagnosing the resulting tissue for changes in cell structure. Indications include:
- second and third degrees. The second degree affects the middle and lower layers of the epithelium, and the third affects all layers, reaching the outer pharynx.
- Leukoplakia (keratinization of the mucous membrane) as a background disease that contributes to the development of cancer pathology in the future.
- Ectropion is a pathological condition of the cervix, in which the mucous membrane of the cervical canal turns into the vaginal part, and also contributes to degeneration into cancer.
- and pseudo-erosion. Erosion is a complete destruction of the epithelium of the cervical canal, while with pseudo-erosion there is an atypical arrangement of the columnar epithelium.
- Cystic formations in this area, including those of endometrioid origin.
- Suspicion of an oncological lesion based on the results of colposcopy or taking a smear from the vagina for cytology.
- Cervical polyps.
- Recurrent dysplasia after surgery.
- Pronounced cicatricial changes in the cervix.
- Identified altered epithelium of the cervix based on the results of colposcopy and smear sampling.
The purpose of conization is to isolate and study the material, so both the changed area and 3-4 millimeters of healthy tissue are captured. The depth of excision largely depends on the method of exposure, but most often it is 5-10 millimeters, which allows you to find out the depth of spread of the pathological process on the cervix.
Radio wave
Radio wave conization is the excision of a pathological area using electromagnetic waves. The operation is performed under local anesthesia, and an anesthetic injection is given into the cervix. The operation is performed on days 5-7 of the cycle in the absence of vaginal discharge. The cervix is fixed in the mirrors, colposcopy is performed, then electrodes are connected and the affected area is removed in a cone shape using a radio knife, capturing from one to two thirds of the cervical canal.
The resulting material is sent for cytology. The whole procedure takes 15-20 minutes. In this case, no sutures are applied, the vessels are coagulated. This reduces the risk of scar changes in the postoperative period.
After the operation, minor sanguineous discharge is observed from the vagina for one to two weeks. During the procedure itself and for several days after, nagging pain in the abdomen is bothersome. The menstrual cycle may be interrupted by 3-5 days. But in general, this operation proceeds without significant changes or complications.
| Indications | Advantages | Contraindications |
|
|
|
Radioconization is one of the most popular, safe and effective techniques.
Electroconization
Electroconization is the removal of affected tissue by cone-shaped excision using an electric current. It is fed to an electrode loop, which removes the affected tissue. The only significant disadvantage of this method is the inability to control the depth of exposure.
The operation is performed under anesthesia on the tenth day of menstruation. First, the doctor dilates the genital tract, removes all vaginal discharge and stains the intended area with a special dye. Before all manipulations, an anesthetic injection is given into the cervix.
Using a loop with electrodes in a circular motion, the affected area is removed 3-4 millimeters beyond the border of changes, while the expected depth will be 5-7 millimeters, the vessels are coagulated. The material is then sent for research.
| Indications | Advantages | Contraindications |
|
|
|
After such an operation, the recovery period lasts about a month. There is also slight vaginal discharge, mild pain in the lower abdomen and changes in the cycle. At this time, it is necessary to observe a protective regime. The procedure can be performed on an outpatient basis.
Electrodiathermoconization, diathermoconization
Electrodiathermoconization is a more extensive intervention, which is recommended to be done only for women who have given birth or for nulliparous women if an oncological process is suspected. Diathermoconization is used for all indications for conization of the cervix. The procedure is suitable for both therapeutic and diagnostic purposes.
It is based on the effect of high voltage electric current, which is created between two electrodes: one is inserted into the vagina, and the other is placed under the woman’s lower back. The manipulation is performed mainly under local anesthesia. The affected area is excised with a special loop, and the vessels are coagulated with electrodes.
Despite the thermal effect and the absence of stitches, after this operation the risk of scarring is quite high. Other complications are also possible, including difficulties with conception and pregnancy, endometriosis.
Full recovery of the body after such a procedure occurs after 2-3 months, provided that all recommendations for the regimen are followed. The operation is scheduled on days 6-8 of the cycle. A full examination is also necessary before it is carried out. Contraindications to the technique are the same as when using electroconization.
Knife, surgical
Knife or surgical conization is the oldest method of cone-shaped excision of altered tissue of the cervix. In this case, the affected area is excised with a scalpel to the required depth and length. Knife conization requires general anesthesia and the operation takes place in a hospital. Currently, it is performed if there are contraindications to radio wave or electroconization, as well as if an oncological process is suspected.
During surgery, tissue can be excised sufficiently to remove cancerous tissue. After the operation, there is a long recovery period; the procedure itself is quite traumatic; it is undesirable to perform it on nulliparous women. The operation is also performed at the beginning of the cycle. After the procedure, high-quality diagnostic material is obtained.
Knife conization of the cervix Laser
Laser conization is based on the use of a laser to remove diseased tissue. This operation also requires general or local anesthesia. The affected area is removed with high precision, but healthy tissue near the removal site may be burned, especially if the woman moves.
Laser surgery allows you to expand the scope during the procedure and is suitable for large areas of damage or bending of the uterus. Vessels are also effectively coagulated, and the risk of postoperative inflammation is minimal.
Laser conization can be used in nulliparous women because it minimizes the risk of scar tissue formation and hormonal changes after the procedure. The operation itself is practically bloodless, but is technically complex and very expensive, which is why the technique is not very popular. It is also difficult to obtain high-quality diagnostic material, since the surrounding tissues are burned.
Cryoconization
Cryoconization involves the destruction of tissue by a cryoprobe under the influence of very low temperatures. They try to carry out the procedure provided that the affected area has small and clear boundaries, and the woman’s age is no more than 30-35 years.
The operation is performed under local anesthesia on an outpatient basis and does not affect reproductive function. A cryo-element is applied to the affected area for 3 minutes, during which the area is destroyed. In this case, it is impossible to obtain diagnostic material, and the tissues located along the borders may be exposed to cold.
After the operation, spasms in the muscles of the uterus and copious watery discharge from the vagina are observed for a long time. Cryoconization is practically not used these days.
PEE of the cervix - what is it?
PEE is a loop excision (excision) of the cervix. The tissue is excised with a heated thin loop to which a low voltage current is applied. Removal and coagulation occur simultaneously. The operation is performed under local anesthesia.
Conization is a deeper version of excision, in which the penetration depth reaches 8-10 millimeters. During excision, more superficial layers are affected.
Collecting a smear during electroconization of the cervix using the Fotek device
When performing electroconization of the cervix using the Fotek device, a high-quality smear is collected. The Fotek device is a generator of high-frequency electrical waves that successfully destroy pathological tissues without damaging healthy ones.
Cervical excision is a more general concept that includes conization. The procedure is performed in various ways, in which the excision of a surface area is carried out to a shallow depth. During excision, diagnostic material can be obtained.
Cone biopsy is a narrower concept than conization. During a biopsy, only diagnostic altered material is collected within the affected and healthy tissues without affecting the altered area. Such a biopsy is performed specifically and solely for diagnostic purposes.
Conization of the cervix: how the operation is performed
Conization of the cervix is an operation and takes place in several stages:
- the first is called preparatory, at this stage an anamnesis is collected and all necessary examinations and consultations are carried out
- treatment stage, in some cases the woman is hospitalized in a hospital;
- Conization ends with a rehabilitation period in which the woman undergoes recovery after the intervention.
The operation itself involves anesthesia, which is carried out both locally and generally, as well as direct intervention on the pelvic organs.
Watch this video about what cervical conization is:
For erosion
For erosion, it is recommended to use electrodiathermocoagulation, radio wave conization of the cervix or excision of the cervix. The procedure can be done on an outpatient basis. First, the woman is seated in a gynecological chair, dilators and speculums are placed, and an anesthetic is injected into the cervical area. After the onset of anesthesia, the affected surface is examined and the boundaries are determined. Next, the erosion site is precisely cauterized with an electrode.
For young nulliparous women, the method of choice is radio wave conization or electroconization, but diathermoconization is best avoided due to the high risk of damage to healthy tissue.
After surgery, you may experience some slight discharge that goes away after a few weeks. The operation area does not require additional processing.
For dysplasia
For cervical dysplasia, the site can be removed by any method, but the method of choice is often electrocoagulation due to the low risk of complications. Diagnostic examination of the material is also a mandatory element, so methods such as laser conization or cryoconization are not suitable.
With dysplasia, a change in the normal tissue architecture occurs, which is a close object of attention due to the possibility of malignancy. An electric knife is used to remove tissue to a depth of 5-7 millimeters and at a distance of 3 millimeters from the border of the lesion. The surface of the neck is first treated with dyes using special techniques to determine the boundaries of removal.
Cyst removal
A cyst is a benign cavity formation with liquid contents. Sometimes cysts are located on the cervix, which complicates the processes of conceiving and bearing a child and serves as an indication for their removal. Common techniques for this are radio wave or electroconization. Sometimes laser removal is used if a woman has already given birth. If the cysts reach large sizes, they must be removed surgically.
Before electroconization, a woman should collect all the necessary tests and consult a therapist who will give her recommendations regarding concomitant pathologies. You should definitely undergo a colposcopy and vaginal smears from a gynecologist, since if there is an infection or inflammation, the procedure will be postponed.
Many patients experience stress and fear before the procedure, so it is useful to take a course of sedatives before the procedure. Drugs for the treatment of underlying diseases do not require discontinuation in the preoperative period. A woman should avoid hypothermia and infections so as not to have contraindications at the time of treatment.
Preparation for the event
Preparation for the procedure consists of collecting tests, consultations with a specialist and procedures on the eve of the intervention. In order to make any variant of conization, you must:
- pass ;
- take a vaginal smear;
- perform a colposcopy;
- culture a smear for bacterial flora;
- do an ultrasound of the pelvic organs;
- according to age indications - mammography;
- visit a gynecologist.
The woman should have a complete gynecological history, including all operations, pregnancies and their outcomes. You also need to make sure there are no sexually transmitted infections. To do this, you can donate blood for antibodies to the relevant pathogens. From general clinical studies it is necessary:
- take general and biochemical blood tests;
- take a general urine test;
- do a coagulogram, determine the blood type and Rh factor, if the intervention is planned in a hospital;
- blood tests for HIV, hepatitis B and C, syphilis;
- do an ECG;
- consult a therapist.
The general practitioner will prescribe additional examinations based on the accompanying background pathologies: monitoring blood sugar levels in diabetes, thyroid hormones in hypo- or hyperthyroidism. All background pathologies must be in a state of compensation. It is imperative to collect an allergy history, especially for anesthetic and narcotic drugs, as well as antibiotics.
A few days before the operation, douching, sex, and the use of any vaginal forms of drugs are prohibited. The day before, you need to carry out hygienic treatment of the skin: shave and wash thoroughly without irritating products.
A light dinner is allowed. If general anesthesia is required, an enema is performed. On the morning of surgery, a light breakfast or no breakfast is allowed under general anesthesia. Taking vital medications is discussed with your doctor. You need to take a hygienic shower.
Why is formaldehyde needed for conization?
Formalin for conization is necessary to preserve the obtained histological material. This environment in which the tissue is placed, exposure to formalin prevents the decomposition of organic tissues and the proliferation of microbes in them. This substance does not enter the woman’s body in any way.
Does it hurt to do
Each woman can answer differently the question of whether conization is painful. During the procedure itself, anesthesia is given: local or general. Sometimes the patient experiences an unpleasant pulling sensation when she is conscious. After anesthesia, pain may intensify: slight nagging pain for two to three weeks after surgery is considered normal. It is allowed to take painkillers and antispasmodics in a short course to relieve symptoms. The following should be of concern:
- pain intensity increased;
- the rhythm of pain has changed;
- began to be accompanied by bloody discharge;
- The pain lasts for more than a month.
Bloody issues If these signs occur, you should consult a doctor.
How long does the operation take?
Conization lasts on average 15-30 minutes if the operation proceeds without complications. The surgical knife method may take longer due to the scale of the actions and last about an hour. If complications develop, such as bleeding or organ rupture, the intervention may take up to two hours. The duration of anesthesia also affects the operation time: half an hour for local and 2-4 hours for general.
Is anesthesia necessary?
Some conization options require general intravenous or epidural anesthesia. Such interventions include:
- laser conization;
- diathermoconization;
- cryoconization.
Laser conization of the cervix Brief general intravenous anesthesia is often chosen for these procedures. Knife conization is performed under full general anesthesia. Other methods are limited to local anesthesia by injecting an anesthetic into the cervix; Lidocaine or Novocaine is often used.
Conization of the cervix and postoperative period
The postoperative period for conization of the cervix greatly depends on the method of operation and its outcomes. Electroconization and radio wave conization are considered low-traumatic, but the use of a laser, high-frequency electric current, low temperatures or a scalpel increases rehabilitation to several months. Also, these methods negatively affect reproductive function and are not used without vital indications for women who have not given birth.
How does healing proceed?
Healing occurs by restoring blood flow to the affected area and the formation of connective tissue at the site of exposure. Scarring reaches a particularly large scale when exposed to a laser, high-frequency electric current or liquid nitrogen. In these cases, significant scarring may form on the cervix.
In other cases, the cavity heals without much of a trace. The condition of the whole organism is of great importance for the restoration of the layer: the absence of inflammation and infections, as well as compliance with the prescribed restrictions.
How long does it last
The healing process lasts from two to eight weeks. With low-traumatic options, after 2 weeks all sanguineous discharge from the vagina stops and pain disappears. After a month, the cycle is restored. With extensive and traumatic exposure, the regeneration process increases to two months.
Temperature
After surgery, the temperature may rise to low-grade levels on the first day. It can also be observed with a burn after a laser or powerful current. The next day the temperature should be normal. Its increase indicates the development of complications - inflammation or infection; it is important to consult a doctor immediately.
How to wash yourself
You should wash yourself regularly; for this you do not need to use any special hygiene products for the skin that can cause irritation, just warm and clean water. Movements should be soft and massaging; all folds of the skin should be thoroughly washed. You should move from front to back.
It is advisable to shave the genital area after surgery in order to better control the condition of the external genitalia. Douching should not be done at this time. Washing should end with careful blotting with a clean, dry towel; do not rub delicate skin and mucous membranes.
Why does pain occur?
Pain after conization occurs due to trauma to the sensitive surface, pain receptors are triggered. There is also a short-term spasm of the smooth muscle fibers of the uterus, which worries the woman for some time due to changes in the structure of the cervical wall: the area is overgrown with connective tissue, the crust falls off at the site of exposure (scab), as well as slight bleeding.
Severe pain after surgery indicates an inflammatory process, severe bleeding or injury to nearby organs.
Causes of itching
The main causes of itching after conization are infectious lesions of the vagina. With candidiasis or thrush, the itching can be unbearable, and voluminous cheesy contents are released from the genital area. With other vaginal dysbiosis, itching may be moderate and accompanied by general discomfort in this area. Skin irritation from hygiene products or synthetic underwear can also cause discomfort.
Before and after conization, the cervix is treated with an antiseptic, often using Lugol's solution or a 3% acetic acid solution, which also makes it possible to identify the boundaries of surface changes. In the future, additional treatment of the cervix is needed only in case of large-scale intervention - in this case, the woman is in the hospital.
What is a scab, what does it look like and how does it come off?
On the wound surface, after removing a defect or altered membrane, a scab is formed - this is a kind of crust of coagulated protein of the underlying tissues and blood cells, which looks like a thin dark film and comes off a few days after the operation. A scab appears with any wound impact on the epithelial surface and is a normal stage of healing.
Will they give me sick leave?
After manipulation on an outpatient basis, sick leave will not be given. If the operation was carried out in a hospital and general anesthesia was given, then it will be issued for 7-10 days, if necessary, it can be extended to 14. If complications develop with any conization technique, a sick leave certificate must be issued for the treatment of the developed complication for the required period.
Contraindications after conization of the cervix
After conization of the cervix, there are certain contraindications that are temporary.
- have sex, both vaginal and anal, unprotected oral;
- perform heavy physical activity;
- lift more than one and a half kilograms;
- use tampons;
- use vaginal suppositories or tablets;
- use special hygiene products;
- do douching;
- go to the pool or sauna;
- swim in open waters;
- wear tight, synthetic underwear.
Douching after conization of the cervix is contraindicated With low-impact methods, they act within a month; with extensive options, such as a laser or a knife, they must be limited to several months.
Medicines such as aspirin and other anticoagulants should be used with caution, as there is still a risk of bleeding after many types of conization.
Discharge after conization of the cervix
After conization of the cervix, slight vaginal discharge of a soft pinkish hue is observed for some time. This applies to variants of the norm. A change in the nature and amount of discharge may indicate the development of a complication.
Norm
The norm is the discharge of a small amount of sanguineous discharge over several weeks with a tendency to decrease. The discharge has a delicate pinkish tint, a concentration of medium viscosity and leaves smearing marks on the laundry. They do not have a pungent odor, the maximum amount disappears during the first day. Towards the end of the rehabilitation period, they become serous and then mucous.
Periods after
The conization operation is performed on days 6-10 of the cycle, after which the next menstruation will begin. They can linger for several days; 3 to 7 are considered normal. Conization does not cause significant hormonal changes, but diseases that are indications for this procedure can disrupt the cycle.
Bleeding is often complicated by:
- laser conization;
- cryodestruction;
- knife conization;
- electrodiathermoconization.
Exposure to high-frequency electrical current does not allow depth control, which can cause unplanned vascular damage. Some pathologies of the uterus and cervix themselves contribute to heavy blood loss: tumors, endometrial damage.
Bleeding after conization is diagnosed by general and specific symptoms. Common ones include:
- weakness, dizziness;
- flickering of flies before the eyes;
- pallor;
- anemia in blood tests;
- frequent heartbeat.
Among the specific ones, the doctor will be alerted to pain in the abdomen and heavy bleeding.
Complications and consequences after conization of the cervix
Conization of the cervix sometimes occurs with undesirable complications and consequences, this is facilitated by both a violation of the surgical technique itself and the somatic background of the patient.
Conization of the cervix if it is not carried out completely can cause the spread of the pathological process, especially of an oncological nature. A traumatic effect on an organ causes a disruption in adaptation and helps stimulate pathological transformations if the impact on the area was not radical and justified.
If high-quality diagnostic material is not obtained when malignant degeneration is suspected, this may lead to an incorrect diagnostic decision and further treatment. It is important to choose the right conization option depending on the indications.
Recovery after conization of the cervix
Recovery after conization of the cervix requires compliance with all prescribed restrictions and contraindications, taking painkillers and anti-inflammatory drugs if necessary.
A woman should adhere to simple recommendations: the patient should protect herself from infections, hypothermia, she must follow a work and rest schedule, and eat well. Anti-inflammatory drugs can be used as symptomatic therapy:
- Ibuprofen;
- Paracetamol;
- Naproxen;
- Ketoprofen;
- Diclofenac.
Medicines should be used in a limited course, combined with proton pump inhibitors in the presence of gastrointestinal pathologies (gastritis or a history of ulcers). These drugs should also be prescribed with caution to persons with cardiac or hematological pathologies.
Locally, you can prescribe drugs that will stimulate recovery or fight microbes. After surgery, a course of antibiotic prophylaxis may be necessary, depending on the extent of the procedure.
Treatment: suppositories, drugs
The following can be used as local medications and suppositories for treatment:
- Depanthol;
- Methyluracil suppositories;
- Levomekol;
- Acylact.
They are effective ten days after surgery. When dysbiosis develops, antimicrobial drugs are prescribed:
- Hexicon;
- Rumizol;
- Terzhinan;
- Diflucan.
Treatment must be selected and agreed upon with a gynecologist after additional examination; self-medication should not be done.
Sex after
Sex after conization is allowed after a month, 4 weeks should be sexual rest. After this period, a woman should resort to protection during sexual intercourse.
Pregnancy and childbirth
Pregnancy and childbirth after cervical conization are possible, but this intervention seriously increases the risk of infertility, especially with extensive exposure. It is not advisable for nulliparous women to do:
- laser conization;
- cryodestruction;
- knife method;
- diathermoconization.
In general, conization is aimed at treating gynecological pathologies leading to infertility, and in some cases helps a woman overcome this problem.
Sports after surgery
Sports after surgery should be reasonably limited: for a week after the intervention, any physical activity other than walking at an easy pace is prohibited. For a month you cannot run, swim, exercise in the gym with weights, jump, or engage in extreme sports. The tension of the anterior abdominal wall should be significantly limited; heavy lifting should not be allowed.
Relapse after conization of the cervix
Often, after cervical conization, recurrence of pathological changes may occur due to incomplete removal of the affected tissue, ongoing hormonal imbalance, or re-formation of a scar if the procedure was done due to cervical scarring. 30-45 days after this, a control examination is done and, and after 2-4 months, a control colposcopy is performed and a smear is taken for cytology, PCR for HPV (human papillomavirus).
Can HPV come back?
After conization of the cervix, HPV may reappear even with complete exposure to the affected area, especially with active, ongoing infection from the outside. Conization is not an absolute protection against HPV, because the virus is located in the epithelium and is active in half of the cases after surgery.
Is repeat surgery necessary?
Often, after recurrence of cervical changes, repeat conization is prescribed, but this increases the risk of complications, especially for nulliparous women. Repeated surgery is sometimes necessary for cicatricial and recurrent dystrophic and ulcerative lesions.
Cost of cervical conization surgery
The cost of cervical conization surgery greatly depends on the technique:
- diathermocoagulation or electroconization cost from 2500 to 5000 rubles;
- radio wave technique will cost 3000-7000;
- The most expensive are laser conization and the knife method - from 40 thousand rubles in private clinics.
The invoice must also include the cost of tests and consultation with specialists. The average bill for preparatory activities will be from 5 to 7 thousand rubles.
Conization of the cervix is the removal of part of an organ for certain indications. Depending on the clinical situation, any of the existing methods can be chosen (electroconization, laser, cryoconization, knife, etc.). To minimize the risk of complications, you must follow all doctor's recommendations after the procedure.
Useful video
Watch this video about why relapse occurs after conization of the cervix:
Firstly, this is a low-traumatic method that allows the patient to maintain her reproductive function.
Secondly, during the procedure, simultaneous coagulation (cauterization) of the bleeding areas occurs, which prevents the possibility of bleeding.
Thirdly, radio wave conization is characterized as a highly precise method of excision of affected tissue, therefore, even with a sufficient depth of exposure, changes in the remaining part of the cervix are minimal.
Experts have also noticed that the formation of scars after the radio wave conization procedure is much less common than after traditional methods of destruction.
Indications:
- cervical dysplasia;
- chronic recurrent erosion;
- an area of altered epithelium discovered during colposcopy.
Contraindications include cervical cancer and inflammatory diseases of the pelvic organs in the acute stage.
Features of the method
Radio wave conization is carried out in the first days after menstrual bleeding, since this completely eliminates the possibility of a woman becoming pregnant and leaves a considerable period of time for healing (regeneration) of cervical tissue.
The duration of the procedure is no more than 15 minutes. The recovery period is approximately 2-3 weeks. During this time, it is not recommended to take a bath, do heavy physical work, or have intimacy.
Radio wave conization at Best Clinic is carried out by highly qualified specialists using modern equipment. The procedure is quite effective, safe and preferable for the treatment of ΙΙ and ΙΙΙ dysplasia. The method is not applied to young women of reproductive age with grade 1 dysplasia (without other changes in the cervix).
Find out which treatment method is right for you! Call the contact numbers listed on our website, or fill out a special form and make an appointment with a SMC Best Clinic specialist. Our doctors see you on weekdays and on weekends, so you can choose any time of visit that is convenient for you.
Content
If the doctor recommends conization of the cervix, then there are good reasons for this. This is a serious operation, during which the center of the cervix with foci of pathologically altered epithelium is cut out in a cone shape. Many gynecologists recommend radio wave conization of the cervix. The doctor who prescribes this procedure should tell you what it is.
Equipment used
Doctors also call radio wave conization diathermoelectroconization. It is carried out with special devices:
- "Surgitron";
- Greenland;
- RadioSurg;
- "Fotek".
These are radio wave surgical generators. With their help, an incision is made into soft tissues and their coagulation using radio waves in the megahertz range.
The radio waves generated by the devices allow you to carefully make an incision and coagulate the wound surface. In this case, postoperative discomfort is minimized, and the likelihood of infection is reduced to zero.
Most devices that use the radio wave method to conize the affected cervix have a “cut with coagulation” mode. It allows not only to cut off the required area, but also to immediately coagulate the treated surface, on which there is a large accumulation of blood vessels. But if necessary, the doctor can first cut out the tissue of the cervix and then carry out coagulation.
Preparing for surgery
Performing radio wave conization of the cervix is considered a planned operation, which is performed after examining the patient. The list of mandatory studies includes the following:
- general urine and blood tests;
- checking the Rh factor, blood group;
- assessment of the blood coagulation system;
- taking bacterial cultures from the vagina and from the surface of the cervix;
- conducting smears for atypical cells;
- extended colposcopy;
- tests for HIV, hepatitis B and C, and other infectious diseases.
It is also advisable to do an ECG and ultrasound of the pelvic organs.
The operation is scheduled after completing all prescribed examinations.
If contraindications to radio wave conization of the cervix are identified, the planned surgical procedure is canceled or postponed.
Features of the operation
Radio wave conization is carried out by gynecological surgeons. The optimal time for its implementation is the 5th – 7th day of the menstrual cycle. This period is chosen because the tissues have time to heal before the next menstruation. In addition, immediately after menstruation there is a high probability of non-pregnancy.
Conization takes 15-20 minutes and is carried out as follows:
- the woman is located in the operating room in a gynecological chair;
- Disposable plastic mirrors are inserted into the vagina (metal mirrors conduct current, so their use during radio wave conization is prohibited);
- all vaginal and cervical discharge is removed with a tampon;
- the cervix is brought down to the vaginal opening and fixed;
- a special electrode is placed under the buttocks;
- the area that is planned to be removed is treated with iodine solution (Lugol) to identify pathologically altered epithelium: the affected areas remain unstained;
- the condition is assessed by colposcopy;
- the conizer is inserted into the center of the cervix, inside the cervical canal;
- the radio wave surgical generator is switched to the “cut” or “cut and coagulation” mode and the required power is selected;
- the conizer itself is rotated around the axis and removed; together with the loop, the part of the cervix cut out by radio waves is pulled out;
- the collected blood is removed with a swab; if necessary, the wound surface and edges are coagulated: this allows the incision to be narrowed.
The cervix is anesthetized by injecting an anesthetic solution (the tissue loses sensitivity after a few minutes). As a rule, a solution of Lidocaine 2% is used. During conization, adrenaline is added to the anesthetic; it is necessary to reduce bleeding.
Local anesthesia can be replaced with general anesthesia if the patient is not affected by drugs, used for local anesthesia, or she is allergic to these medications. Intravenous anesthesia is also given to women who experience severe fear.
The use of local anesthesia is possible due to the fact that the conizer heats up to no more than 55 0C. Tissues are cut under the influence of radio waves, not high temperatures. The area is captured so that not only the pathological epithelium is cut out, but also 3-4 mm of healthy tissue. This minimizes the likelihood that some problem area will remain. The standard cone depth is 5-8 mm.
Indications for surgery
Understanding what radio wave conization of the cervix means should be done by those patients who:
- stage 2–3 dysplasia was detected, confirmed by histological examination;
- part of the cervical mucosa turns into the vagina (ectropion);
- A PAP test showed that there are cancerous or precancerous cells in the cervix;
- Colposcopy revealed that there is a prismatic epithelium on the cervix, which is normally located in the cervical canal.
Radio wave conization allows not only to remove the problem area, but also to examine tissue to identify cancer cells. If the patient had dysplasia, then during the operation the pathologically changed cells are cut out. This method is considered an effective method for treating dysplasia.
The procedure allows you to detect invasive cancer in its early stages. Thanks to this, the effectiveness of surgical treatment increases to 97%.
List of contraindications
In some cases, doctors do not even recommend radio wave conization. The list of contraindications includes:
- period of pregnancy and breastfeeding;
- presence of menstrual bleeding;
- invasive cervical cancer;
- various infectious and inflammatory diseases of the genitourinary system;
- exacerbation of chronic diseases.
If possible, radio wave conization is postponed. The operation is performed after there are no contraindications to its implementation.
If invasive cancer is confirmed, the planned radio wave conization is canceled, and the woman is sent to an oncology clinic.
Recovery period
After radio wave conization, patients recover quite quickly. The woman is left under observation for 2-4 hours, then she can be sent home.
In the first days of the postoperative period, patients complain of nagging, aching pain. The appearance of heavy discharge after surgical bleeding is considered normal. They can be serous-bloody or brown, in some they are whitish with various inclusions.
On days 5-8, the process of scab removal begins. This is the name given to the accumulation of dead cells that forms during coagulation of the wound surface. The process of scab rejection begins after new epithelium has formed under it. Sometimes its discharge is accompanied by an increase in the intensity of blood discharge.
The patient's condition should be monitored by a doctor. If bleeding begins or severe sharp pain appears, an urgent consultation with a gynecologist is required. The woman may need hospitalization.
You should see your doctor 2 weeks after the operation. He must evaluate the condition of the cervix and make sure that there are no negative consequences of radio wave conization of the cervix. During the examination, a colposcopy is performed and a smear is taken for cytology. For 5 years after surgery, it is necessary for the patient to visit a gynecologist once every 3 months.
The cervix heals after radio wave conization in most women within 4 weeks. After the first menstruation, it should be completely covered with new epithelium. But in some cases, the recovery process may be delayed - this depends on the body’s individual ability to regenerate tissue and the volume of tissue removed.
To prevent complications some gynecologists prescribe antibacterial therapy.
Established restrictions
It is possible to prevent the development of complications after radio wave conization of the cervix if you follow the recommendations of doctors. They prohibit:
- intense physical activity;
- lifting weights (from 5 kg);
- swimming in open reservoirs, pools;
- visiting baths, saunas;
- douching;
- use of tampons;
- sexual acts.
These recommendations must be followed for 6 weeks from the date of surgery. When heavy discharge appears and at the beginning of menstruation, you can only use sanitary pads. It is easy to injure an unhealed cervix, so any manipulation with penetration into the vagina is prohibited.
Possible complications
After performing radio wave conization of the cervix, negative consequences occur extremely rarely. But the possibility of their occurrence cannot be ruled out. Therefore, a woman needs to know in which cases an urgent consultation with a gynecologist is required.
Possible postoperative complications include:
- bleeding;
- infection of the wound surface;
- stenosis (pathological narrowing) of the cervical canal.
Bleeding is possible if not all vessels were cauterized during surgery. It can also begin when the scab comes off. This situation is possible if the new epithelium has not yet fully formed or it was damaged during the process of crust rejection.
You should contact a doctor if you notice an unpleasant odor in your discharge. This indicates a possible infection. You should also consult a doctor if your body temperature rises (if it rises to a level of 37.5 0C or higher).
The first and second periods after conization differ from normal ones: they pass more abundantly. Their duration also increases. But, as a rule, by the third cycle the condition is completely normalized.
Long-term complications of radio wave conization include:
- deterioration of fertility (possibly due to stenosis of the cervical canal or impaired properties of cervical mucus);
- development of isthmic-cervical insufficiency during pregnancy.
Isthmic-cervical insufficiency is a fairly rare complication of conization. But if the patient has been diagnosed with this, then she must strictly follow all the recommendations of the gynecologist. In this condition, the cervix is unable to support the growing fetus - it begins to open. The likelihood of late miscarriage, the onset of premature labor, or infection through an open cervical canal increases.
But you should not refuse radio wave conization due to the risk of complications. They appear in only 1-3% of patients.
In 2% of cases, photodynamic therapy cannot be used without conization. It is required to clarify the diagnosis in case of significant cicatricial deformities of the cervix and in those rare cases when (PDT) as the method of choice is impossible.
Yes, this is not a reservation. I practice a therapeutic and organ-preserving approach to treatment, and the results speak for themselves - in 98% of cases, surgical conization of the cervix is not necessary. It is not required even to obtain a tissue sample (biopathic specimen) for histological examination. Why?
On the one hand, even at stage 1B cancer we have more than 80% chance of a process proceeding without metastases. On the other hand, after photodynamic therapy, the patient remains under my quarterly monitoring for a year, and any negative dynamics are immediately corrected by a repeat PDT procedure, and, if necessary, by surgery.
I am a practicing surgeon, so many of my conclusions were drawn from my own experience. At the end of the article, I will tell you which conization method I use in my practice and why.
Advantages
The method allows you to obtain an ideal biopath for histological examination and establish the diagnosis as accurately as possible.
Disadvantages of the method
Of all the methods of conization of the cervix, this method is considered the most traumatic. Conization with a scalpel causes heavy bleeding, has a long postoperative period and the highest percentage of complications:
- narrowing (stenosis) of the cervical canal, which leads to infertility;
- isthmic-cervical insufficiency, which is fraught with miscarriage at 16-36 weeks due to spontaneous dilatation of the cervix, and it will not be possible to do without suturing the cervix;
- scars formed after the procedure make it difficult to transform the cervix into the birth canal and require a cesarean section for delivery;
- Impaired cervical mucus production increases the risk of infection of the uterus and fetus.
Method 2. Loop conization of the cervix with an electric knife (electroconization of the cervix, LEEP, LLETZ)
In the USA, the procedure is called LEEP - Loop electrosurgical excision procedure, in Europe - LLETZ - Large loop excision of Transformation zone. The medical name for this procedure is excision.
Video of loop conization of the cervix -
A high-frequency electric current heats a thin wire loop, which at temperatures above 80 ° C acquires the properties of a scalpel.
For the operation, the size and shape of the loop (semicircular, square or triangular) is selected in such a way as to remove the transformation zone in one pass.
After the operation, the bleeding vessels are “cauterized” with a spherical electrode.
High conization with removal of the inner region of the cervical canal is performed a little differently. It uses a so-called “sail” electrode.
The electrode is inserted into the cervix and rotated once or twice. This removes the cone-shaped area of the cervix.
The operation ends with treating the wound with an antiseptic.
Flaws
- The thermal effect on the tissue remains, and cell death still occurs in the incision area.
Method 5. Laser conization of the cervix
Laser conization of the cervix is usually performed with a CO2 (carbon dioxide) laser.
If you dive into physics, lasers are a high-energy flow. Lasers for laser surgery operate in several modes.
1. The beam, less than 1 mm in diameter, is used like a laser scalpel. They use it almost the same way as a regular scalpel - they excise a cone. Using a laser in this mode is considered unreasonably expensive, although it allows you to obtain a biopath with almost no charred edges.
2. 2-3 mm beam is used to evaporate tissue. This process is also called vaporization, destruction or ablation.
Under the influence of the high energy of the laser beam, the water in the tissues heats up and evaporates in a fraction of a second. Evaporates along with tissues.
Laser ablation is carried out with micron precision - depending on the settings, to a depth of 20 to 200 microns. Therefore, to carry out conization to a significant depth, several laser passes are required.
The depth of vaporization when using a laser is 2-3 mm on the cervix, and up to 5-6 mm in the cervical canal area. Therefore, laser conization is used only for treatment of first degree dysplasia, less often – the second.
The laser requires high precision, therefore, in order to exclude accidental movements of the patient, laser conization is always performed under general anesthesia.
Disadvantages of laser conization
Laser conization has a very significant drawback. I do not use it in my practice, because after this procedure it is impossible to obtain tissue for reliable histology - in the vaporization mode, taking a biopath is impossible, and in the scalpel mode, the tissues have extensive thermal damage, which makes the biopath unsuitable for a full histological examination.
The laser method also has one more drawback - not all surgeons can get used to non-contact work with tissues.
In the article we looked at various types of cervical conization. In my practice, I prefer the loop radiosurgical method. On the one hand, minimal thermal damage to tissue is the key to rapid healing of the cervix. On the other hand, this technique, in combination with RDV curettage of the cervical canal, provides complete and most reliable information about the current diagnosis.
One PDT procedure eliminates the virus in the cervical canal and is the most reliable existing method for lifelong prevention of recurrence and cervical cancer.
