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Operations: Cauterisation of lesion of cervix uteri (including loop diathermy)

Insurance code: Q0230 (in conjunction with P2730 if colposcopy carried out at same time).

Introduction: This information is written by John Fairbank and is provided for the benefit of his patients. Additional information will be given during consultation in the clinic and during the pre-operative discussion. It is not appropriate for all surgeons’ individual practice or for all patients.

Purpose of operation: Cauterisation of the cervix is most commonly carried out to remove tissue and to reduce excess vaginal discharge. Diathermy loop excision is the commonest procedure used to treat the cervix after an abnormal cervical smear.

Description of procedure: Cervical cautery involves treating the central area of the cervix with a hot metal ball similar to a soldering iron. The treated skin is destroyed and when it heals it grows back with skin similar to the skin on the hand which produces less discharge. Diathermy loop excision is carried out with a thin wire loop which shaves off a piece of cervical tissue. The treatment is normally carried out to a depth of 1 cm to remove the affected area without damaging the cervix for future fertility. The piece of tissue removed is sent to the pathologist for the area of abnormality to be graded and to ensure there is no cancerous tissue present in the sample which would require further treatment.

Anaesthetic: These procedures are most commonly carried out under local anaesthetic in the Colposcopy suite but are sometimes done under light general anaesthetic for ease of access or for comfort.

Length of stay: Day case if general anaesthetic and outpatient appointment if local.

Post-operative management: A watery blood stained discharge is normal and expected for one month following the treatment. If there is a heavy, smelly or very bloody discharge this is normally the signs of infection and a short course of antibiotics are required. Sex, soaking in the bath and prolonged tampon use are best avoided for one month following cervical treatment to reduce the risk of infection.

Potential complications: Bleeding at the time of treatment is unusual. The commonest complication is bleeding, which occurs 10 – 14 days after treatment. These bleeds are usually due to infection and require a course of antibiotics. Augmentin 375 mgs three times a day for 7 days is a good choice for ladies who can take penicillin. If you are allergic to penicillin a 7 day course of Cephalexin at a dose of 250 mgs four times a day and Metronidazole 200 mgs three times a day can be given. Rarely, the bleeding can be quite heavy and require a stitch through the cervix to stop the bleeding. This usually requires a general anaesthetic and happens in less than 1% of cases. Cervical treatment on a single occasion is not thought to affect either fertility or pregnancy outcome. In cases of repeat treatment there is a small risk to both fertility and pregnancy and supporting stitches around the cervix are sometimes required. Mr Fairbank or the colposcopist will usually provide advice about this at the time of treatment, and at follow up visits.

Post-operative consultation: A repeat smear test are normally organised for 6 months after treatment although this is reduced to 4 months if someone is hoping to get pregnant. Colposcopy follow up examination are sometimes required at the time of the follow up smear.

Relevant websites:

A very good overview of colposcopy and treatment of the cervix.

www.windsorcolposcopyclinic.co.uk (link to John Fairbank’s colposcopy clinics)