The Effect of Tamponade on Postoperative Bleeding after Electrical Loop Excision of the Transformation Zone (LLETZ)

Abstract

Background: This two-armed clinical audit aimed to evaluate the effectiveness of vaginal tamponade in reducing postoperative bleeding after large loop excision of the uterine cervix’s transformation zone (LLETZ). Methods: We included patients after LLETZ with and without vaginal tamponade in this clinical audit analysis. In January 2021, we stopped performing routine postoperative vaginal tamponade after LLETZ, intensively monitored the occurrence of bleeding 30 days after the procedure, and analyzed the clinical audit. We compared the data with the clinical audit from 2016, when we performed routine postoperative tamponade in all patients. The primary outcome of our analysis was to evaluate the effect of vaginal tamponade on reducing the incidence of postoperative bleeding, necessitating secondary intervention. The secondary outcome was the occurrence of postoperative infection necessitating antibiotic treatment. All patients in the study signed written consent to analyze their data for quality control. Results: A total of 301 patients (132 patients with and 169 patients without postoperative tamponade) were included in the study and were similar regarding baseline characteristics. Postoperative bleeding occurred in 16 (5.3%) patients of both groups and was more prevalent in patients with vaginal tamponade compared to patients without the tamponade, although the difference was not statistically significant (6.1% vs 4.7%, respectively, p = 0.616). Postoperative infection occurred in 8 (2.7%) patients of both groups, and the incidence was similar in both groups (3.0% vs 2.4%, respectively, p = 0.734). Conclusions: According to our results, routine tamponade after LLETZ does not help reduce the incidence of postoperative bleeding.

Keywords

• lletz
• postoperative bleeding
• vaginal tamponade
• postoperative infection
• surgery
• conization