Loop electrosurgical excision procedure (LEEP) for abnormal cervical cell changes

Surgery Overview

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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 health professional'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 examination table with your feet raised and supported by footrests (stirrups). Your health professional 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.

Medication is injected to numb the cervix (cervical block). If a cervical block is used, an oral pain medication or pain medication given into a vein (intravenous, or IV) may be used in addition to the local anesthetic.

What To Expect After Surgery

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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 health professional

Call your health professional 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 indicate an infection

Why It Is Done

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LEEP is done after abnormal Pap test results have been confirmed by colposcopy and cervical biopsy. LEEP may be used to treat:

• 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 that can be removed.

How Well It Works

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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

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• After the surgery, a small number of women (less than 10%) may have significant bleeding that requires vaginal packing or a blood transfusion.²
• Infection of the cervix or uterus may develop (rare).
• Narrowing of the cervix (cervical stenosis) that can cause infertility may occur (rare).
• Once a woman has had LEEP, she has a higher risk of delivering a baby early.³

What To Think About

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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 health professional. Once several Pap test results are normal, you and your health professional 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

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Citations

1. Martin-Hirsch PL, et al. (2006). Surgery for cervical intraepithelial neoplasia. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

2. Nuovo J, et al. (2000). Treatment outcomes for squamous intraepithelial lesions. International Journal of Gynecology and Obstetrics, 68(1): 25–33.

3. Samson SA, et al. (2005). The effect of loop electrosurgical excision procedure on future pregnancy outcomes. Obstetrics and Gynecology, 105(2): 325–332.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Denele Ivins
Associate Editor	Pat Truman
Primary Medical Reviewer	Joy Melnikow, MD, MPH - Family Medicine
Specialist Medical Reviewer	Barbara S. Apgar, MD, MS - Family Medicine, Women's Health
Specialist Medical Reviewer	Ross Berkowitz, MD - Obstetrics and Gynecology
Last Updated	January 12, 2007