LEEP

What is LEEP/LLETZ?

LEEP stands for loop electrosurgical excision procedure also known as large loop excision of the transformation zone. This procedure is done in order to remove a type of abnormal tissue growth in the cervix called cervical dysplasia. It uses a thin wire loop attached to an electrical unit.

When is it used?

Cervical dysplasia is most often discovered from a Pap test, a test which most women should have every year. Several types of cervical dysplasia can become cancer if not treated. Removal of the abnormal cells can help prevent cancer of the cervix. There are other ways of treating the abnormal cells such as:

• freezing, burning, or using a laser to remove the abnormal tissue
• surgical removal of the tissue with a knife
• removal of the uterus.

How do I prepare for LEEP?

You will be given the option of taking Valium 1 hour prior to your appointment to help you relax. You will need to have someone drive you to and from the appointment. There are no dietary restrictions. You will need to avoid sexual intercourse for 4 weeks after the procedure. Also avoid douching and using tampons during this time.

What happens during the procedure?

This procedure is done in the office by Dr. Hardy and will be scheduled during a time when you are not having your menstrual period.

You lie on a treatment table and put your feet in stirrups, just as you would for a pelvic exam. Dr. Hardy will then look at your vagina and cervix through a colposcope, which is like a magnifying glass. He will then put a solution on the cervix to highlight the problem areas on the cervix. Once he sees the area where the dysplasia is, he numbs the cervix with a local anesthetic such as lidocaine. He then removes the abnormal tissue with the wire loop. The loop is used to scoop out the abnormal tissue in one piece and to seal any bleeding blood vessels. A medicated paste is then put on the cervix to further reduce the risk of bleeding. All you may feel is a slight tingling. The procedure takes about 5 minutes and the removed tissue is sent to a lab for testing.

What happens after the procedure?

You can return to normal school or work activity the next day. You may have a little cramping after the procedure. You may also have some minor bleeding or spotting the first day or so after the procedure. For about 4 weeks you will have a brownish discharge. This is a normal part of the healing of your cervix. Your cervix should heal completely within a month. You should avoid heavy lifting, tampons, douching, sexual intercourse, and hot tubs for 1 month after the procedure.

You will need to have pap smear tests every 4 months for the first year and then every 6 months for the second year. Once they are all normal, you may then be able to return to yearly pap smear tests.

You will be required to come for a follow up appointment in about 3-4 weeks. At this time, your cervix should be completely healed.

What are the benefits of this procedure?

LEEP allows Dr. Hardy to locate and remove precancerous cells. It does not require a general anesthetic, which might be necessary if the tissue were removed surgically. It can be performed in the office.

What are the risks of this procedure?

• Bleeding is the main complication of a LEEP procedure. Serious bleeding requiring prolonged observation, stitches or even blood transfusion is very rare.
• Some times all of the abnormal cervical tissue is not removed completely. This problem is identified when the removed tissue is sent to the lab to be evaluated by a pathologist.
• Rarely the cervix may become infected. Infection may cause the opening in your cervix to become narrower. The narrowing might make it more difficult for you to get pregnant.
• The tissue of the cervix may be weakened. This is called an incompetent cervix and it could cause a premature birth of a baby if you become pregnant.

When should I call the office?

Call office right away if:

• You have a fever over 100°F (37.8°C).
• You have severe abdominal pain.
• You have any discharge from your vagina that has a bad odor.
• You have bleeding that lasts more than 1 week.