• Loop Electrosurgical Excision Procedure

    (LEEP, LLETZ—Large Loop Excision of the Transformation Zone, LLEC—Large Loop Excision of the Cervix, Loop Cone Biopsy of the Cervix)

    Definition

    Loop electrosurgical excision procedure (LEEP) uses a thin wire loop to precisely cut out areas of the cervix. The cervix is a neck-like structure that connects the vagina and uterus. LEEP is done to remove abnormal cervical cells.

    Reasons for Procedure

    LEEP is often done after abnormal cells have been found on the cervix. These abnormal cells are often found on a Pap test . If the cells found on a Pap test show cervical dysplasia (abnormal cells) or cancer cells, a LEEP may be done.

    Possible Complications

    If you are planning to have LEEP, your doctor will review a list of possible complications, which may include:
    • Bleeding
    • Abdominal cramping
    • Infection
    • Future pregnancy problems (small increased risk of premature births and having a low birth weight baby)
    • Narrowing of the cervix (very rare)
    • Incomplete removal of the abnormal tissue
    • Accidental cutting or burning of normal tissue
    Some factors that may increase the risk of complications include:
    • Menstruation at the time of the procedure—It is best to have LEEP done when you do not have your period.
    • History of pelvic inflammatory disease
    • Inflammation of the cervix
    • Pregnancy or possible pregnancy
    • Being overweight
    • Smoking
    Be sure to discuss these risks with your doctor before the procedure.

    What to Expect

    Prior to Procedure

    In the weeks leading up to the procedure:
      Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Anti-inflammatory drugs (eg, aspirin )
      • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
    The day of the procedure:
    • If your doctor will be giving you a sedative, arrange for someone to drive you home from the clinic.
    • If directed by your doctor, take a pain reliever right before the LEEP.
    • Bring sanitary napkins to use after the procedure.

    Anesthesia

    Local anesthesia is often used for a LEEP. This will keep you from feeling pain during the procedure. You will be awake during the procedure. The anesthesia may be applied with a lotion or injected into the area.

    Description of the Procedure

    You will lie on your back on a table with your feet up in foot rests. The doctor will insert a speculum into your vagina. This tool will separate the vaginal walls. This will allow the doctor to see the cervix. Anesthesia will be applied to the cervix to numb the area.
    The doctor will then apply a solution to the cervical area. The solution will show the abnormal area that needs to be removed. The doctor will insert a thin wire into the vagina toward the cervix. You will hear a vacuum-like noise. You may also hear a humming noise. The thin wire loop is like a surgical knife. The doctor will be able to gently remove the abnormal tissue. You will need to stay very still. The doctor will cauterize the area. This process heats the blood vessels to stop bleeding. A paste may also be applied to stop bleeding.

    How Long Will It Take?

    LEEP only takes a few minutes.

    How Much Will It Hurt?

    You may feel cramping during LEEP. You should not feel any sharp pain.

    Post-procedure Care

    At the Care Center
    Your blood pressure and heart rate will be checked. Once you are feeling okay, you will be able to go home.
    At Home
    After the procedure, you may have:
    • Dark brown-black vaginal discharge for several days
    • Mild cramping
    • Watery pink discharge
    When you return home, do the following to help ensure a smooth recovery:
    • Rest when you get home.
    • Frequently change the sanitary pad.
    • Take pain medicine as directed.
    • It will take a few weeks for your cervix to heal. For four weeks:
      • Do not use tampons or douches.
      • Refrain from sexual intercourse.
      • Do not do any heavy lifting.
      • It is okay for you take baths and showers.
    • If advised by your doctor, have a Pap test and pelvic exam every six months.

    Call Your Doctor

    After arriving home, contact your doctor if any of the following occurs:
    • Heavy bleeding (more than your normal period)
    • Bleeding with clots
    • Severe abdominal pain
    • Fever or chills
    • Unusual odor or discharge
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Family Physicians http://www.aafp.org/

    American Congress of Obstetricians and Gynecologists http://www.acog.org/

    CANADIAN RESOURCES

    Canadian Women’s Health Network http://www.cwhn.ca/

    Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org/

    References

    American Congress of Obstetricians and Gynecologists. Management of abnormal cervical cytology and histology. Practice Bulletin. 2010; 99.

    Emam M, Elnasar A, Shalen H, Barakat R. Evaluation of a sinfle-step diagnosis and treatment of premalignant cervical lesions by LEEP. Int J Gynaecol Obstet . 2009;107(3):224-7.

    LEEP patient pamphlet. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/publications/patient%5Feducation/bp110.cfm . Accessed April 10, 2009.

    Neff D. Endometrial ablation. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated May 2009. Accessed September 30, 2009.

    Noehr B, Jensen A, Kjaer SK. Depth of cervical cone removal by loop electrosurgical excision procedure and subsequent risk of preterm delivery. Obstet Gynecol . 2009;114(6):1232-8.

    Patient fact sheet: LEEP. American Society for Colposcopy and Cervical Pathology website. Available at: http://www.asccp.org/pdfs/patient%5Fedu/leep.pdf . Accessed April 10, 2009.

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