OVERVIEW
The loop electrosurgical excision procedure (LEEP) uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. LEEP is also known as large loop excision of the transformation zone (LLETZ). The procedure can be performed in the office with local pain medicine like novacaine or in the hospital with complete general anesthesia.
LEEP is done to remove of dysplastic (precancerous) cells after abnormal Pap test results have been confirmed by colposcopy and cervical biopsy.
HOW IT IS DONE
Office Procedure
You will need to take off your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie on your back on an exam table with your feet raised and supported by footrests (stirrups). Your doctor will insert an instrument with curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined.
Medicine is injected to numb the cervix (cervical block). If a cervical block is used, an oral pain medicine or pain medicine given may be used in addition to the local anesthetic.
What To Expect After Surgery
Most women are able to return to normal activities within 1 to 2 days after LEEP is performed. Recovery time depends on how much was done during the procedure.
Mild cramping may occur for several hours after the procedure.
A dark brown vaginal discharge during the first week is normal.
Vaginal discharge or spotting may occur for about 4 weeks.
Sanitary napkins should be used instead of tampons for about 3 weeks.
Sexual intercourse should be avoided for about 4 weeks.
Douching should not be done.
Call your doctor if you have any of the following symptoms:
-A fever
-Heavy bleeding (usually bright red) that last is not your period
-Increasing pelvic pain
-Bad-smelling, yellowish vaginal discharge, which may point to an infection
How Well It Works
LEEP is a very effective treatment for abnormal cervical cell changes. During LEEP, only a small amount of normal tissue is removed at the edge of the abnormal tissue area.
After LEEP, the tissue that is removed (specimen) can be examined for cancer that has grown deep into the cervical tissue (invasive cancer). In this way, LEEP can help further diagnosis as well as treat the abnormal cells.
LEEP is as effective as cryotherapy or laser treatment. If all of the abnormal cervical tissue is removed, no further surgery is needed, though abnormal cells may recur in the future. In some studies, all the abnormal cells were completely removed in as many as 98% of cases.
Risks
Infection of the cervix or uterus may develop (rare).
Narrowing of the cervix (cervical stenosis) that can cause infertility may occur (rare).
After a woman has had LEEP, especially a large LEEP or multiple LEEPs, there is a higher risk of preterm labor or cervical incompetance.