--
Richard Chudacoff, MD, FACOG
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
Siegel, M.D.
Sent: Tuesday, October 30, 2007 10:43 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Gyn: Positive margins on a LEEP
Dear all:
For some reason (the chart is not with me today), I had told the patient
that I wanted to do another LEEP, probably because I seem to remember
that the original biopsy said invasion could not be ruled out--which is
different than what I posted below. I also discussed this with the gyn
onc.
So. . .if I posted wrong, I'm sorry, but this has generated good
discussion.
She is scheduled for a LEEP this week, and likely a hyst later.
How to hyst?
Since she is having pain, I feel that a laparoscope must be involved, so
I'll likely do an LAVH since I'll need to go vaginally to look at the
cervix and remove it fully.
Thanks to all,
Garry
At Tue, 30 Oct 2007, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.
wrote:
>
>At Mon, 29 Oct 2007, Garry E. Siegel, M.D. wrote:
>>
>>33 YO P2002 S/P TL, originally came in for dysmenorrhea and dyspareunia.
>>
>>Her intial exam was normal, but her pap was HGSIL. Directed biopsies at
>>satisfactory colposcopy showed moderate dysplasia.
>>
>>LEEP in the OR--CIS with positive endo and ectocervical margins, and
>>extensive glandular involvement.
>>
>>What's next?
>>
>>Garry
>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>>
>- repeat pap in 3-6 months, new wet prep brushs are just as good as ECC.
>- Hyst, sure if that's what pt. wants, usually if pt. has other
>pathology,adenomyosis, endometriosis , they don't need much convincing.
>
>Very common problem, have had over a dozen in the last ten years, only
>had one actual reccurence or incomplete excision show up on follow up
>PaP, just repeated leep and patient has been -ve for five years, some
>women just don't want a hyst.
>Quite a few had low grade lesion on follow up PAP's which eventually
>turned normal.
>
>--
> Take care, John
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
