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Meloni P, Izzo S, De Intinis C, Simari T, Motzo M, Picazzo R, Brizio R, Vignale C, Molle M, Izzo L, Izzo P. Rare Complication Post-Conization for Cervical Dysplasia: Rectovaginal Fistula. Clin Pract 2023; 13:1025-1034. [PMID: 37736927 PMCID: PMC10514833 DOI: 10.3390/clinpract13050091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023] Open
Abstract
(1) Background: High-grade cervical dysplasia is primarily caused by human papillomavirus (HPV) infection. Conservative surgery is the preferred treatment approach for this condition. The most commonly employed technique is the loop electrosurgical excision procedure (LEEP), which involves removing the affected portion of the cervix. Excisional treatments are often curative, and complications are typically rare and minor. (2) Methods: The loop electrosurgical excision procedure (LEEP) is the standard method used for conservative surgery in high-grade cervical dysplasia. It entails the excision of the specific area of the cervix where the abnormal cells are present. The procedure employs a wire loop carrying an electrical current to remove the affected tissue. (3) Results: Excisional treatments, such as LEEP, have shown to be effective in treating high-grade cervical dysplasia. They have a high success rate in eliminating abnormal cells and reducing the risk of cervical cancer. Complications associated with LEEP are infrequent and usually minor. Short-term complications may include bleeding, which can be managed easily. Long-term complications may involve cervical canal stenosis, which can impact fertility. (4) Conclusions: Conservative surgery, particularly the loop electrosurgical excision procedure (LEEP), is the preferred and effective treatment for high-grade cervical dysplasia caused by HPV infection. It offers a high cure rate with rare and minor complications. While short-term bleeding is a common occurrence, it is manageable. Long-term complications such as cervical canal stenosis may impact fertility. However, an extremely rare and possibly unique complication described in this case is the development of a vaginorectal fistula. This complication is likely due to indirect thermal injury resulting from compromised tissue. Further research is needed to better understand and prevent such complications.
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Affiliation(s)
- Paolo Meloni
- SC Ostetricia Ginecologia, Ospedale Imperia, ASL1 Imperiese, 18038 Sanremo, Italy; (P.M.); (M.M.)
| | - Sara Izzo
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 80138 Naples, Italy; (S.I.); (M.M.)
| | - Claudia De Intinis
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, viale del Policlinico 155, 00161 Rome, Italy; (C.D.I.); (L.I.)
| | - Terenzia Simari
- Ambulatorio Specialistico Ginecologia Ostetricia, ASL1 Imperiese, 18038 Sanremo, Italy;
| | - Mariangela Motzo
- SC Ostetricia Ginecologia, Ospedale Imperia, ASL1 Imperiese, 18038 Sanremo, Italy; (P.M.); (M.M.)
| | | | - Rodolfo Brizio
- SC Anatomia Patologica, ASL1 Imperiese, 18038 Sanremo, Italy; (R.B.); (C.V.)
| | - Cristina Vignale
- SC Anatomia Patologica, ASL1 Imperiese, 18038 Sanremo, Italy; (R.B.); (C.V.)
| | - Marcello Molle
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 80138 Naples, Italy; (S.I.); (M.M.)
| | - Luciano Izzo
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, viale del Policlinico 155, 00161 Rome, Italy; (C.D.I.); (L.I.)
| | - Paolo Izzo
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, viale del Policlinico 155, 00161 Rome, Italy; (C.D.I.); (L.I.)
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Denny L, Quinn M, Sankaranarayanan R. Chapter 8: Screening for cervical cancer in developing countries. Vaccine 2008; 24 Suppl 3:S3/71-7. [PMID: 16950020 DOI: 10.1016/j.vaccine.2006.05.121] [Citation(s) in RCA: 184] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 05/31/2006] [Indexed: 12/11/2022]
Abstract
Organised and quality assured cytology-based screening programmes have substantially reduced cervical cancer incidence in many developed countries. However, there are considerable barriers to setting up cytology-based screening programs, particularly in developing countries. This has stimulated the search for novel and alternative approaches to cytology for cervical cancer prevention. These approaches generally perform as well as cytology, and sometimes better, although many of them have a lower specificity, resulting in higher false-positive rates. The possibility of linking screening to treatment in a one- or two-visit strategy appears to be safe, feasible and effective. Barriers to establishing screening programs and the pitfalls encountered differ from one country to the next. Country-specific solutions need to be found, while being cognizant of the criteria that have enabled successful screening programmes.
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Affiliation(s)
- Lynette Denny
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
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