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666 Laparoscopic uterovaginal recanalization for severe cervical stenosis secondary to loop electrosurgical excision procedure: video presentation
  1. Murat Api1,
  2. Esra Keles1 and
  3. Ismail Baglar2
  1. 1University of Health Sciences, Kartal Dr. Lütfi Kirdar City Hospital, Departmant of Gynecologic Oncology, Istanbul, Türkiye
  2. 2University of Health Sciences Turkey, Kartal Lütfi Kirdar City Hospital, Department of Obstetrics and Gynecology, Istanbul 34668, Turkey, Istanbul, Türkiye

Abstract

Introduction/Background Cervical stenosis is the most common serious complication following Loop Electrosurgical Excision Procedure (LEEP) for treatment of cervical dysplasia. Rates of cervical stenosis after LEEP are reported between 1.3 to 19%. We report a case of severe cervical stenosis successfully treated with laparoscopic approach whereby the steps of surgical technique have been thoroughly described in the video presentation.

Methodology A 33-year-old primiparous woman presented with severe cyclical monthly pelvic pain following a LEEP treatment for CIN II lesion 12 months ago. Gynecological examination revealed an almost amputated cervix with no visible cervical external ostium. Transvaginal ultrasonography identified hematometra and bilateral hematosalpinx. Several surgical attempts with a transvaginal balloon catheter under the transabdominal ultrasonographic guidance have been tried. These attempts all failed since no visible cervical tissue could have been found upon vaginal inspection, patient was scheduled for laparoscopy.

Results The endometrial cavity was entered anteriorly via a 3–4 mm incision at the level of the isthmocervical portion after dissecting the bladder. Through this incision, a laparoscopic grasper was gently pushed down for creating a proper route to reach the vagina while other members of the team created a small incision on the site of the indentation of the grasper. A silicon No. 16 Foley catheter tip was grasped with this instrument and pulled back through this route into the abdominal cavity. The catheter tip was then re-inserted into the uterine cavity. The patient was discharged on postoperative day 1 with the catheter left for the next one-month period. The patient was prescribed oral estradiol hemihydrate with oral medroxyprogesterone acetate treatment. The catheter was removed and the patient’s regular menstruation resumed with the resolution of all previous symptoms.

Conclusion Laparoscopic uterovaginal recanalization may be considered as an alternative surgical approach for treatment of severe cervical stenosis.

Disclosures None.

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