Acta Obstet Gynecol Scand 1999; 78: 900–905 Copyright C Acta Obstet Gynecol Scand 1999 Printed in Denmark ¡ All rights reserved Acta Obstetricia et Gynecologica Scandinavica ISSN 0001-6349 ORIGINAL ARTICLE Loop diathermy or laser excisional conization for cervical intraepithelial neoplasia LARS O. VEJERSLEV 1 ,LARS SCHOUENBORG 3 ,FLEMMING SØRENSEN 1 ,DORTE NIELSEN 3 , SØREN STAMPE SØRENSEN 1 ,BIRGITTE RAVN JUHL 2 ,CARSTEN RYGAARD 4 AND JETTE JUNGE 4 From the 1 Departments of Obstetrics and Gynaecology and 2 Pathology, Copenhagen County Hospital Glostrup, and the 3 Departments of Obstetrics and Gynaecology, and 4 Pathology, Hvidovre Hospital, Denmark Acta Obstet Gynecol Scand 1999; 78: 900–905. C Acta Obstet Gynecol Scand 1999 Background. Cervical intraepithelial neoplasia (CIN) can be managed by ablative or ex- cisional procedures. We have compared the excision time, effectiveness, and safety of loop diathermy (loop) against laser conization. Methods. In a prospective study in two hospital departments 222 women were randomized to loop or laser conization. Data were collected by questionnaires after operation and at two follow-up examinations. Results. At department A (122 women), two physicians performed 27% of the loop and 35% of the laser excisions; at department B (100 women), the corresponding figures were 69% and 59%. Loop was quicker than laser conization in both departments (median 3–4 min versus 10–20 min), while laser conization was more time consuming in department A (median A/ BΩ20/10 min). Peroperative bleeding dominated during the laser procedure in both depart- ments and complicated the loop procedure more frequently in department A. Postoperative bleeding occurred with equal frequency in the four groups (41.8%, 52.7%, 59.2%, 64.7%). At both departments, bleeding for more than two weeks was reported twice as often after laser conization (A:13.8%, B:24.2%), when compared to loop excision (A:7.1%, B:13.7%). Residual CIN was found in all of three re-conizations and in one of eight hysterectomy specimens. Conclusions. Loop was quicker than laser excision, per- and postoperative bleeding dimin- ished, and the success rates were comparable. Physicians mastered Loop excision after a few attempts. However, the results improved, when performed by a restricted number of phys- icians. Histological incomplete excision indicates close colposcopic and cytologic follow-up to identify residual CIN. Key words: cervical intraepithelial neoplasia; diathermy loop excision; laser conization Submitted 20 November, 1998 Accepted 30 April, 1999 Cervical intraepithelial neoplasm (CIN) can be managed by ablative (cryotherapy or laser ab- lation) or excisional (cold-knife, CO 2 laser, or loop diathermy) procedures. In Denmark, cold-knife or CO 2 laser conization was previously preferred for investigation and treatment after a histologic diag- nosis of CIN II and III or persisting CIN I. Suc- cess and complication rates were comparable (1), Abbreviation: CIN: cervical intraepithelial neoplasia. C Acta Obstet Gynecol Scand 78 (1999) but laser conization requires a shorter period of hospital stay and may be managed in an outpatient setting. Loop diathermy has been advocated as a feasible alternative (2–8), and has in some centers replaced cold knife (9,10) or laser conization (11). In contrast, the conclusions from comparative studies in other centers were that in general the laser (12, 13) or cold knife (14) treatment was pref- erable. In this prospective, randomized study we have compared the excision time, reliability, effective-