Loop Electrosurgical Excision Procedure (LEEP)

Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by electric current to remove cells and tissue in a woman’s lower genital tract. It is used as part of the diagnosis and treatment for abnormal or cancerous conditions.

The lower genital tract includes the cervix and vagina. The cervix is the lower, narrow part of the uterus and the vagina connects the cervix and the vulva.

With LEEP, an electric current passes through the fine wire loop to cut away a thin layer of abnormal tissue. This tissue will be sent to the lab for testing. LEEP can also remove abnormal cells to allow healthy tissue to grow.

LEEP can:

•  Cut away abnormal cervical tissue that can be seen during colposcopy.
•  Remove abnormal tissue high in the cervical canal that cannot be seen during colposcopy.

LEEP is also known as large loop excision of the transformation zone (LLETZ).

A vinegar or iodine solution, which makes abnormal cells more visible, may be applied to the cervix before the procedure is done.

How it is done

LEEP is usually done at your doctor's office, a clinic, or a hospital as an outpatient/inpatient procedure. You do not have to spend a night in the hospital.

You will then lie on your back on an exam table with your feet raised and supported by footrests (stirrups). Your doctor will insert a lubricated tool called aspeculum 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 into a vein (intravenous, or IV) may be used along with the local anesthetic.

What to Expect After Surgery

Most women are able to return to normal activities within 1 to 3 days after LEEP is performed. Recovery time depends on how much was done during the procedure.

After LEEP

•  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 3-4 weeks.
•  Pads should be used instead of tampons for about 3-4 weeks.
•  Sexual intercourse should be avoided for about 3-4 weeks.
•  Douching should not be done.

When to call your doctor

Call your doctor now or seek immediate medical care if:

•  You have severe vaginal bleeding. You are passing clots of blood and soaking through your usual pads each hour for 2 or more hours.
•  You have pain that does not get better after you take pain medicine.
•  You have signs of infection, such as:Increased pain, vaginal discharge that smells bad, or a fever.

Why It Is Done

LEEP may be done when cervical or vaginal problems are found during a pelvic exam, or abnormal cells are found during a Pap test. LEEP is also done to detect cancer of the cervix or vagina.Cells that appear to be abnormal, but are not yet cancerous, may be called precancerous. These abnormal cells may be the first evidence of cancer that could develop years later. The abnormal changes may be Minor cell changes called low-grade squamous intraepithelial lesions (LSIL) that may be precancerous and that persist after a period of watchful waiting. Moderate to severe cell changes can be removed.

LEEP may also be used to assist in the diagnosis or treatment of the following conditions:

•  Polyps (benign growths)
•  Genital warts, which may indicate infection with human papilloma virus (HPV), a risk factor for developing cervical cancer.

Your healthcare provider may have other reasons to recommend LEEP.

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 removed in as many as 98% of cases.

Risks

•  Infection of the cervix or uterus may develop (rare).
•  After a woman has had LEEP, she has a higher risk of delivering a baby early.
•  Bleeding
•  Changes or scarring in the cervix from removal of tissue
•  Trouble getting pregnant due to narrowing of the cervix (cervical stenosis) is rare.