Loop diathermy or laser excisional conization for cervical intraepithelialneoplasia

Background. Cervical intraepithelial neoplasia (CIN) can be managed by abla tive or excisional procedures. We have compared the excision time, effectiv eness, and safety of loop diathermy (loop) against laser conization. Methods. In a prospective study in two hospital departments 222 women were randomized to loop or laser conization. Data were collected by questionnair es after operation and at two follow-up examinations. Results. At department A (122 women), two physicians performed 27% of the l oop and 35% of the laser excisions: at department B (100 women), the corres ponding figures were 69% and 59%. Loop was quicker than laser conization in both departments (median 3-4 min versus 10-20 min), while laser conization was more time consuming in department A (median A/B=20/10 min). Peroperati ve bleeding dominated during the laser procedure in both departments and co mplicated the loop procedure more frequently in department A. Postoperative bleeding occurred with equal frequency in the four groups (41.8%, 52.7%, 5 9.2%, 64.7%). At both departments, bleeding for more than two weeks was rep orted twice as often after laser conization (A:13.8%, B:24.2%), when compar ed to loop excision (A:7.1%, B:13.7%). Residual CIN was found in all of thr ee re-conizations and in one of eight hysterectomy specimens. Conclusions. Loop was quicker than laser excision, per- and postoperative b leeding diminished, and the success rates were comparable. Physicians maste red Loop excision after a few attempts. However, the results improved, when performed by a restricted number of physicians. Histological incomplete ex cision indicates close colposcopic and cytologic follow-up to identify resi dual CIN.