Table 4. Articles that refer to cervical stenosis following conization (Medline 1986-2005).
| Authors, year | Total population and study design | Definition of cervical stenosis | Procedure reported in the study | Incidence of stenosis found (%) | Time at which the stenosiswas diagnosed | Prognostic factorfor stenosis | Studylimitation |
|---|---|---|---|---|---|---|---|
| Baldauf et al., 199610 | 532 patients who underwent conization (laser or electrosurgery) – retrospective observational study | Narrowing that prevented insertion of a 2.5 mm Hegar dilator into the cervical canal | Laser cone (n = 255)LLETZ-cone (n = 277) | 10.2 4.3 | 94.7% of cases within the first six months. | Endocervical lesion, RR: 4.10 (95% CI: 1.75 – 9.61) Height of cone ≥ 20 mm, RR: 4.33 (95% CI: 1.57-11.92) | Doubt regarding whether the length of follow-up for the LLETZ-cone group was enough to diagnose all the cases of stenosis. |
| Ferriset al.,199512 | 198 patients who underwent electrosurgical procedures. Multicenter prospective cohort | Inability to pass a small cotton-tipped swab into the endocervical canal | LLETZ LLETZ-cone | 3.8 25.9 | Not described. | LLETZ-cone, RR 5.65 (95% CI: 1.35-23.69) Height of cone ≥ 10 mm, p = 0.002 | 31% of patients were lost from follow-up. |
| Suh-Burgmannet al.,20001 | 164 patients who underwent to electrosurgical procedures Retrospective observationalstudy | Requirement for dilation with an endocervical curette of 3.0 mm diameter to collect endocervical samples | Procedures with diathermy loop | 6 | Not described. Follow-up lasting one year. | Volume of the excised tissue greater than 6.6 mm3, RR 1.32 (95% CI: 1.1-1.67)Previous history of electrosurgical procedure | Was follow-up period long enough? |
| Houlardet al.,20029 | 238 patients who underwent to laser conization. Prospective study | Cervical narrowing preventing insertion of a 4.0 mm diameter cotton swab into the cervical canal | Laser cone | 16.8 | Not specified. Total length of follow-up of 26 months. | Age > 40 years RR 4.95 (95% CI: 1.8-8.6) | |
| Brunet al.,200213 | 241 patients who underwent conization. Retrospective observational study | Inability to introduce a 2.5 mm Hegar dilator into the cervical canal | Cold knife (n = 100); Laser cone (n = 39); LLETZ-cone (n = 102) | 8 27 3 | First 12 months after operation. | Laser cone p < 0.001 | Was follow-up period enough? Other prognostic factors were not tested. |
| Mathevetet al.,20038 | 86 patients who underwent conization (cold knife, laser, and LLETZ-cone). Randomized clinical trial | Inability to introduce a 3.0 mm Hegar dilator into the cervical canal | Cold knife (n = 37); Laser (n = 37); LLETZ-cone (n = 36) | 14.3 0 3.4 | First six months after surgery. Total length of follow-up of 36 months. | Cold knife, p = 0.03 and 0.06 when compared with laser and LLETZ-cone, respectively. Volume of the cone ≥ 2.1 cm3, p = 0.001 | Suggestion that a study with a bigger sample size should be conducted to prove results. The method for blinding of envelopes was not explained. |
| Pennaet al.,20057 | 1218 patients who underwent laser conization, 7.8% after menopause Retrospective observational study | Cervical narrowing that prevented the insertion of a 2.5-3 mm Hegar dilator to collect endocervical cytology | Laser cone | 7.1 | First six months after surgery. | Hormone replacement therapy was a protective factor OR 4.82 (95% CI 1.45-16.08) | Significant difference between the groups when nulliparity and endocervical lesion were compared. |
LLETZ = large loop excision of the transformation zone;
RR = relative risk; CI = confidence interval; OR = odds ratio.