Loop Electrosurgical Excision Procedure LEEP

Introduction – Loop Electrosurgical Excision Procedure LEEP

The loop electrosurgical excision procedure (LEEP) involves use of a thin, low-voltage electrified wire loop to cut out abnormal tissue. LEEP is performed for:

  1. Cutting away abnormal cervical tissue that has been seen during colposcopy.
  2. Removing abnormal tissue high in the cervical canal that cannot be seen during colposcopy. In this situation, LEEP is preferred over a cone biopsy.

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

A vinegar (acetic acid) or iodine solution may be applied to the cervix before the procedure, which makes abnormal cells more visible.

Procedure:

LEEP is usually performed at the doctor’s office, a clinic, or a hospital as an outpatient procedure. There is usually no need to spend a night in the hospital.

LEEP is a very efficient treatment for abnormal cervical cell changes.
Patient needs to take off the clothes below the waist and she is draped by surgical gown around the waist. Patient then lies on the back on an exam table with feet raised and supported by footrests or stirrups. The doctor inserts a thin, curved instrument with curved blades (speculum) into the vagina. The speculum gently spreads apart the vaginal walls, allowing visualization of the inside of the vagina and the cervix.

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

After the surgery

Most women are able to return to their normal activities within 1 to 3 days after LEEP is performed. Recovery time depends on the extent of tissue removed during the procedure.

Mild cramping may occur for several hours after the procedure.

A dark brown vaginal discharge can occur during the first week after LEEP.

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 be avoided.

The gynecologist should be contacted if there are any of the following symptoms:

  1. A fever
  2. Spotting or bleeding for more than 1 week
  3. Bleeding that is heavier for a normal menstrual period
  4. Increasing pelvic pain
  5. Bad-smelling, yellowish vaginal discharge, which may be symptoms of an infection

Indications:

LEEP is done for patients in whom the abnormal Pap test results have been confirmed by colposcopy and cervical biopsy. LEEP may be used to treat:

  1. Minor cell changes called low-grade squamous intraepithelial lesions (LSIL) which may be precancerous and persist even after a period of watchful waiting.
  2. Moderate to severe cell changes which are amenable to removal.

Results:

LEEP is a very efficient 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 by microscopy for cancer that has grown deep into the cervical tissue (invasive cancer). Hence, LEEP can help in further diagnosis as well as treatment of the abnormal cells.

LEEP is as effective as cryotherapy or laser treatment. If all of the abnormal cervical tissue is possibly removed, no further surgery is needed. However, the abnormal cells may recur in the future. In some studies, all the abnormal cells were removed in more than 98% of cases.

Risks:

  1. Infection of the cervix or uterus may rarely develop.
  2. Narrowing of the cervix (cervical stenosis) that can cause infertility.
  3. After LEEP, there is higher risk of delivering a baby early (premature delivery).

Other considerations:

  • Loop electrosurgical excision procedure (LEEP) is less expensive and easier to perform than cone biopsy or carbon dioxide laser treatment.
  • A biopsy can also be done to confirm the abnormal cervical cell changes before a LEEP procedure is done.
  • After undergoing LEEP, regular follow-up Pap tests are very important. A Pap test should be repeated every 4 to 6 months or as recommended by the gynecologist. After several Pap test results are normal, then future schedule of the Pap tests is decided.

- Link of interest: Gynaecology News on Twitter

This article is not medical advice nor a substitute to professional health advice. Always consult a doctor.

 

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