What is commissioning?
Conization is a small surgical procedure, generally performed on an outpatient basis with the aim of removing cervical lesions highlighted during colposcopy and cervical biopsy. More specifically, the conization intervention removes a small part of the cervix, generally cone-shaped (hence the term conization), including the cervical canal for a variable part of its height.
Conization intervention generally preserves the woman's ability to have children, although it can increase the risk of incompetent cervix, and therefore of premature birth in the case of subsequent pregnancies.
How to do it
Conization can be performed with different techniques under colposcopic guidance, each with its advantages and disadvantages; beyond what is expressed, it is obviously up to the doctor to describe the individual methods to the patient and the reasons that lead him to prefer one rather than another:
- conization with a cold blade scalpel → traditional surgical excision, requires hospitalization and general or less frequently local anesthesia → increases the risk of bleeding compared to other techniques, but provides better histological samples → this technique has limited use today, for example for lesions of glandular origin (which go deeper)
- conization with diathermic loop → conization takes the name of LEEP ( Loop Electro Escission Procedure ) or LLETZ (large loop excision transformation zone) → tissue removal occurs by cutting and coagulation at the points where the electrode comes into contact with the tissue. This results in minimal thermal damage on the edges of the cut, therefore the reading of the histological preparation is not hindered → low bleeding risk, low costs
- conization with CO 2 laser → takes the name of laserconization → it can be performed in both outpatient and day surgery with local anesthesia → allows the respect of healthy tissue but sometimes can damage the histological sample, also has high operating costs
The removal of the cone of cervical tissue allows for histological examination, providing the anatomopathologist with useful information on the nature and extent of the lesions. In addition to representing an important therapeutic technique, therefore, conization can also be defined as a diagnostic technique, while the adjective " conservative " emphasizes the ability to NOT substantially alter the architecture and physiology of the uterus.
Due to its characteristics, conization is defined as an "excisional" treatment. In this sense, it is distinguished from other surgical techniques classified as "destructive": in the latter case the abnormal area, visualized by colposcopy, is eliminated with techniques that exploit cold or heat, such as DiaTermo-Coagulation (DTC ), cryotherapy or laser-vaporization. Such techniques do NOT allow the histological examination of the tissue to be performed, as this is destroyed: hence the "destructive" attribute.
When is it indicated?
The destructive techniques listed above are generally reserved for cases of mild dysplasia (CIN 1 or LSIL) or in any case limited to the esocervice, while the cases of moderate or severe dysplasia (CIN II, CIN III or HSIL) and carcinoma in situ should be addressed with techniques ablative, generally resolutive (therapeutic conization).
The excisional intervention may also include the use of hysterectomy, therefore surgical removal of the uterus in its entirety, indicated in case of already invasive carcinoma (in this case the conization is probably not a definitive treatment). In addition to the severity of the injury, the choice between conization and hysterectomy is made based on age, the woman's desire for future pregnancies and the history of relapses after conservative treatments.
Risks and complications
Conization is a simple and safe operation, but at the same time delicate. Generally performed under local anesthesia, it can cause discomfort or mild pain when injecting the anesthetic into the cervix. In most cases, the operation has a short duration, about 10-20 minutes, and the woman can immediately return home; other times the operation is longer and requires hospitalization for 24 hours.
In exceptional cases, complications can arise such as:
- bleeding during surgery
- post-operative haemorrhage (after 2-3 weeks, at the time of the fall of the so-called escarra by diathermocoagulation or detachment of the hemostatic points → not to be confused with the normal presence of blood loss of varying duration in the post-intervention days)
- cervical stenosis with fluid retention in the uterine cavity
- infections and inflammations
- lesions of the bladder or rectum
- uterine perforation
Complete recovery of the cervix generally occurs within a few weeks after surgery. The pain present in the following days can possibly be controlled by the use of painkillers.
Heavy exercise should be avoided in the first few days, while no contraindication exists for normal work, study and school activities.
After 3-6 weeks a normal sexual life can be resumed and vaginal swabs can be used.
Results
In most cases (> 90%, up to 97%) conization proves to be an adequate and decisive therapy, regardless of the technique used. Despite this it is good not to lower the guard: an accurate monitoring of the patient after the intervention is essential to prevent and identify any recurrence.
