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Conization

Conization of the cervix is an operation where one part of the cervix is removed in the form of a cone when cellular changes that can lead to the development of cancer have been previously diagnosed by biopsy, or when cervical cancer has been detected at an early stage.

Conization removes the part of the cervix that contains the transformation zone. The transformation zone is the border between two types of cells: of the cylindrical cells found in the cervical canal and the squamous cells found on the cervix and from these changes cervical cancer can develop.

Cell changes-dysplasias or so-called precancerous changes occur in the transformation zone and cervical cancer can develop from these changes. That is why it is important to remove the part with the transformation zone during conization.

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When is conization performed?

Conization is done when a biopsy of the cervix, that is, by taking small pieces of tissue from the cervix and taking part of the tissue from the canal of the cervix, shows that there are changes in the cells that can develop into cancer. These are changes that are classified as CIN II and CIN III, which stand for cervical intraepithelial neoplasia of the 2^nd and 3^rd grade;

in the case when the diagnosis of CIN I, cervical intraepithelial neoplasia of the first grade is confirmed multiple times by biopsy, and there are also positive human papillomaviruses (HPV) of a high degree of risk;
in cervical cancer of the grades 0 and 1A1;
in case of a long-term bleeding from the cervix without the presence of cellular changes, in case the bleeding cannot be resolved by conservative methods

Methods used:

Loop conization

Classical conization

Laser conization

This is the method we most often perform in the Gyn-Fertility Clinic Milenković.

It is conization with a loop that is connected to some source of energy, usually low voltage current or radio waves. This type of conization is called LOOP conization. The terms LEEP from the English term loop electrosurgical excision or LLETZ from large loop excision of the transformation zone.

Today, this method is most often performed due to minimal bleeding during and after conization, and with modern devices, tissue damage is minimized and does not complicate histopathological analysis.

Classic conization is done with a scalpel, the cone-shaped part is removed, then the cervix is reconstructed and stitched with a surgical thread.

(This method facilitates the histopathological examination since there is no thermal damage to the tissue, but there is more bleeding during the intervention and an increased risk of bleeding after conization, as well as a longer recovery)

In this method, a laser beam is used to cut the tissue and to stop the bleeding.

This method takes longer time, thermal tissue damage exists, but is minimal with modern devices. The risk of bleeding during and after conization is minimal.

Before the intervention

Procedure

After conization

The patient fills out a detailed questionnaire about her health condition.
If the procedure is performed under general anesthesia, a consultation with the anesthesiologist is held.
If the patient has certain additional risk factors, an examination by a doctor of another specialty, usually a specialist in internal medicine is required.
If it is done under general anesthesia, the patient does not eat or drink for 6-8 hours before the intervention.

Patients who use aspirin or other blood thinners must stop using the drug 7 days before the planned intervention.

Upon arrival at the Clinic, a needle is inserted into the patient's vein so that she can receive the necessary medication.
Conization is done on the gynecological table. During conization, a colposcope (microscope) is used to see the transformation zone and locate the changes that need to be removed.
The vagina is washed with a saline solution or an antiseptic agent containing iodine or chlorine.
A part of the cervix with a cone-shaped transformation zone is removed. Depending on the size of the cervix and the transformation zone, it is determined how much tissue will be removed, and accordingly, a loop or triangle-shaped electrode is chosen if “LOOP conization” is performed.
Sometimes, after conization, a tissue sample is also taken from the cervical canal of the uterus (curettage of the cervical canal). If the patient is bleeding more than usual, compression gauze is placed in the vagina, which is removed after a few hours.

The tissue that is removed is sent for histopathological examination. The result of histopathological analysis is obtained 7-10 days after conization.

The patient stays in the Clinic for 1-2 hours.
Heavy bleeding and brown discharge can be expected up to 3-4 weeks after conization.
Menstrual pain and cramps can be expected a few days after the intervention.
It is not recommended to use vaginal tampons, take a bath and swim as long the bleeding lasts.
Sexual intercourse is not recommended for 3-4 weeks after conization.
The patient can return to daily activities a day or two after conization.
If the patient performs heavy physical work, a break of 5-7 days is advised. Light training can be started a few days after conization, depending on how the patient feels.
Antibiotics after conization are not necessary unless there is an additional risk factor. Paracetamol is recommended for pain, tablets 500 mg up to 4 times a day.

Check-up after conization is done depending on the histopathological findings. Most often, a check up with a Papanicolaou test (PAP smear) is scheduled 3 months after conization.

Expert advice: frequently asked questions

Answered by: Milan Milenković, MD, PhD

What method is used in the Gyn-Fertility Clinic Milenković?

In our Clinic, “LOOP conization” is most often performed under local anesthesia. “LOOP conization” is performed quickly, there is minimal bleeding during the intervention and a small risk of bleeding after the intervention. With the modern device we use, histopathological analysis is not made difficult. Conization is done under general anesthesia if the patient does not want it to be done under local anesthesia.

Classical conization with a scalpel is rarely performed, and most often when it is necessary to perform a second conization, that is, when pathological changes were not removed by the first conization or they appear again after some time.

What anesthesia is used for conization?

Conization can be done under local and under general anesthesia.

In our Clinic, “LOOP conization” is most often performed under local anesthesia, but the decision on anesthesia is made in agreement with the patient.

Classic scalpel-conization is performed under general anesthesia.

The type of anesthesia does not affect the operative procedure itself.

Is conization painful and are there any pains after it?

Conization is not painful as it is done under anesthesia.

After conization, menstrual pain and cramps can be expected for several days. Paracetamol tablets, 500 mg - 2 tablets up to 4 times a day are recommended against pain.

When the intervention is not recommended and what are possible complications?

Conization is not performed:

- in case of an infection of genital organs;

- during the menstrual bleeding.

Although rare, complications can include:

- heavy bleeding;

-narrowing of the cervical canal due to scar tissue - cervical stenosis;

- increased risk of preterm labor if most of the cervix is removed;

- infection.

When can I start training after conization?

You can start training again 5-7 days after conization, and the intensity of the training should be adjusted to how you feel.

When can I start having sex after conization?

It is advised to avoid sexual intercourse for 3-4 weeks after conization due to the risk of bleeding.

How much does conization cost in the Gyn-Fertility Clinic Milenković?

You can see the price of conization in our regularly updated price list.

When is it advisable to get pregnant after conization?

It is advised to wait 3 months after conization before trying to get pregnant. A longer period of time from conization to pregnancy reduces the risk of preterm labor.

Can conization be done more than once?

Conization can be done several times if the precancerous changes are not completely removed the first time, or if they appear again after some time. The uterus is removed as a last resort when dysplasia-precancerous changes last for several years, and the patient no longer wants to give birth.

10.

When can in vitro fertilization be done after conization?

It is advised to wait 3 months after conization before trying to get pregnant. A longer time period from conception to pregnancy reduces the risk of preterm labor.

11.

Is there a risk of preterm labor and pregnancy complications after conization?

Conization increases the risk of premature birth before 37 weeks of pregnancy by 1.5-2 times, as well as the risk of premature leaking of the amniotic fluid and lower birth weight of children. Women who have had more than one conization have a 10 times higher risk of premature birth.

When the time from conization to pregnancy is longer, the risk of premature birth is decreased. It is advised to wait at least 3 months before trying to get pregnant. It is very important that women who have not given birth or plan to have more children undergo conization with minimal tissue removal and avoid unnecessary interventions on the cervix.

12.

In which cases should you contact the Clinic/doctor?

After the conization, you should immediately contact the Clinic (telephone 069 50 22222 or info@drmilenkovic.com) or the nearest on-call facility in case of heavy bleeding, severe pain and elevated body temperature.

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