LLETZ Procedure in an Outpatient Setting: Applicability and Cost-Effectiveness

We present the applicability and cost-effectiveness of the large loop excision of the transformation zone (LLETZ) procedure in outpatient settings – anesthesia, postoperative pain, postoperative stay, and complications such as intraoperative bleeding, early postoperative bleeding, infection, late cervical canal stenosis, spotting, incomplete epithelialization, inadequate colposcopy). From Jan 1, 2017, to Jul 31, 2021, 189 patients underwent LLETZ at Medical Center “Prof. Kornovski”. The methodology includes the indications for performing the LLETZ procedure, the preparation of the patients, a description of the procedure, tools, technical parameters, the operation technique, and the postoperative period. We present the duration of the procedure; analgesics in terms of intraoperative bleeding; postoperative pain; postoperative stay; early postoperative complications (bleeding, infection); late postoperative complications (stenosis of the cervical canal, incomplete epithelialization, spotting before menstruation, and inadequate colposcopy). The LLETZ procedure is applicable in outpatient practice with low intra- and postoperative complications and minimum stay. Two main factors determine its cost efficiency in outpatient practice: the use of local anesthesia instead of general anesthesia requiring an anesthesiologist, anesthesiology nurse, anesthetic for short-term venous anesthesia, and the daily cost for an occupied bed – a financial factor in-hospital care versus the lack of daily cost per occupied bed in outpatient care.