Surgery Overview
The loop electrosurgical excision procedure
(LEEP) uses a thin, low-voltage electrified wire loop to cut out abnormal
tissue. 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. In this situation,
LEEP may be done instead of a
cone biopsy. (For more information, see
cone biopsy.)
LEEP is also known as large loop excision of the
transformation zone (LLETZ).
A vinegar (acetic acid) 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 procedure (you do not
have to spend a night in the hospital).
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 into a vein (intravenous, or IV) 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 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 weeks.
- Sanitary napkins should be used instead of tampons
for about 3 weeks.
- Sexual intercourse should be avoided for about 3
weeks.
- Douching should not be done.
When to call your doctor
Call your doctor if you
have any of the following symptoms:
- A fever
- Spotting or bleeding that
lasts longer than 1 week
- Bleeding that is heavier than a normal
menstrual 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 removed
in as many as 98% of cases.1
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, she has
a higher risk of delivering a baby early.2
What To Think About
Loop electrosurgical excision
procedure (LEEP) is less expensive and easier to perform than cone biopsy or
carbon dioxide laser treatment.
A
biopsy is done to confirm the abnormal cervical cell
changes before a LEEP procedure is done.
If you have LEEP, you
need regular follow-up Pap tests. A Pap test should be repeated every 4 to 6
months or as recommended by your doctor. After several Pap test results are
normal, you and your doctor can decide how often to schedule future Pap
tests.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
References
Citations
- Garcia F, et al. (2012). Intraepithelial diseases of the cervix, vagina, and vulva. In JS Berek, ed., Berek and Novak's Gynecology, 15th ed., pp. 574–618. Philadelphia: Lippincott Williams and Wilkins.
- Samson SA, et al. (2005). The effect of loop
electrosurgical excision procedure on future pregnancy outcomes.
Obstetrics and Gynecology, 105(2): 325–332.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Kirtly Jones, MD - Obstetrics and Gynecology |
|---|
| Last Revised | December 28, 2010 |
|---|
Garcia F, et al. (2012). Intraepithelial diseases of the cervix, vagina, and vulva. In JS Berek, ed., Berek and Novak's Gynecology, 15th ed., pp. 574–618. Philadelphia: Lippincott Williams and Wilkins.
Samson SA, et al. (2005). The effect of loop
electrosurgical excision procedure on future pregnancy outcomes.
Obstetrics and Gynecology, 105(2): 325–332.
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