The Prevalence, Risk Factors, and Management of Residual Cin Following Primary Leep at Kenyatta National Hospital,a Cross-sectional Study.

Abstract

Introduction. Cervical cancer is the second most common cancer in women in developing countries. Cervical cancer screening is the principal preventive measure in detection of cervical intraepithelial lesions. Colposcopy and conservative treatment of intraepithelial lesions detected on screening, has gained prominence due to few complications, good tolerance from patients and the preservation of fertility. Loop Electrosurgical Excision Procedure (LEEP) is one of the conservative treatment options, one of cervical cone biopsy procedures. Its expected outcome is complete excision of lesions, with free surgical margins as the indicator. The presence of positive margins after excision and histological analysis is an indicator of residual disease. Reviewed studies had shown a prevalence of positive margins of between 10-45%. HIV status, reproductive health parameters of patients have been associated positively with residual disease. Subsequent management of these patients with residual disease vary form one center to another. Objective.To determine the prevalence, socio-demographic, clinical characteristics and management of patients with residual HSIL on histology following primary LEEP at KNH. Methodology. This was a retrospective cross-sectional study of patients who had undergone colposcopy and primary LEEP in clinic 66 of Kenyatta National Hospital between October 2014 and December 2017. Records of 191 patients who had undergone LEEP during the period under review were retrieved and analyzed.

Results. The prevalence of residual disease among women with CIN post primary LEEP at KNH was 19.6%. No associations were found between residual disease and age, HIV status, parity, years since last delivery and contraception. The follow up review rate after six months was 70.8%. Total Abdominal Hysterectomy was the commonest subsequent management modality upon review of these patients at 70.5%. Other review modalities were Pap smear and EUA. No patients underwent ECC or Repeat LEEP. Conclusion.The prevalence of residual disease among women with CIN post primary LEEP at KNH was 19.6%. No associations were found between HIV status, reproductive health characteristics and residual disease.