Loop electrosurgical excision procedure (LEEP)

Description
Loop electrosurgical excision procedure (LEEP) is a method used to remove abnormal tissue from the cervix with a thin wire loop attached to an electrosurgical generator. This procedure is also known as large loop excision of the transformation zone (LLETZ).

Anatomy
The cervix is the neck of the uterus, the female reproductive organ that houses the embryo and fetus during pregnancy. It opens into the vagina.

Indications
LEEP is most often done to treat abnormal cells in the cervix that may develop into cervical cancer if left untreated. These abnormal cells may be referred to as dysplasia, cervical intraepithelial neoplasm (CIN) or squamous intraepithelial lesion (SIL). Less commonly, LEEP is used to treat or remove noncancerous lesions such as moles or other growths. The loop can remove any lesions intact.

Patient preparation
LEEP cannot be done during your period or when you have an infection of the cervix or uterus. Before the procedure, your doctor may instruct you to take an over-the-counter (OTC) pain reliever. Also, arrange for someone to drive you home after the procedure. You may feel a little lightheaded from the medication or have some discomfort from cramping.

Procedure
Although every surgery has its own standard procedure, your individual health history could play a role in any variation to the procedure. Discuss these issues with your doctor.
LEEP can be done safely in the doctor's office. You'll be positioned on your back on the exam table with your feet in stirrups. First, a speculum (an instrument that helps the doctor see inside the vaginal canal) is placed in your vagina and the doctor uses a colposcope (an instrument used to examine the vagina and cervix through a magnifying lens) to examine your cervix. Then, an electrosurgical pad covered with gel is placed on your thigh to act as a safe path of return for the electrical current. A vinegar solution is applied to your cervix or vulva to help the doctor see the extent of the abnormal tissue. A local anesthetic is injected to numb the cervix. Then, the abnormal tissue is removed with the wire loop, which acts as a cutting and sealing tool. A vacuum is used to remove any smoke generated by the sealing. To prevent further bleeding, a solution is applied to the treated areas.

The entire procedure takes about 10 to 30 minutes, and the actual tissue removal takes less than a minute or two. The doctor will send the tissue sample for lab analysis, where a pathologist (a doctor who specializes in diagnosing abnormal changes in tissues) determines if the abnormal tissue was completely removed. Lab analysis also provides the most accurate evaluation of tissue.


Postprocedure care
Before going home, you'll wait in the doctor's office for a short time. After the procedure, you may have light vaginal bleeding or mild cramping. Take pain medication as recommended by your doctor. For up to one week after the procedure, you may also notice a watery, brownish-black discharge from the solution that was applied to prevent bleeding. A thin discharge may last two to six weeks. Do not do any heavy lifting (more than 15 pounds). Do not douche, use tampons, or have vaginal intercourse for three weeks or as recommended by your doctor.
Consult your doctor if you:

have fever or a foul-smelling discharge
begin to bleed more heavily than a menstrual period
bleed for more than a couple days
are in severe pain
Also, be sure to follow up with your doctor regarding the test results. Schedule an appointment for a Pap smear or colposcopy within the next three to six months, or as recommended by your doctor. Even if your results are normal, keep all follow-up appointments for Pap smears and screenings.


Benefits
LEEP can be done in the doctor's office with a local anesthetic in a short period of time. This also reduces the cost of the procedure. For most women, the entire abnormal area is removed with the first treatment.
Other benefits include:

little bleeding
minimal recovery with few activity restrictions
minimal complications compared to other procedures
Also, because there is minimal tissue damage, LEEP provides a good specimen to help the doctor evaluate your risk of cervical cancer.


Risks
You may feel minor discomfort when you're given the local anesthetic. As with any procedure, there is a slight risk of bleeding or infection. There is also a highly unlikely risk of reaction to the local anesthetic or unintentional burns from the electric current. After the cervix is treated, about 1 percent of women experience a narrowing of the cervix.

Considerations
Again, LEEP cannot be done during your period or when you have an infection of the cervix or uterus. LEEP has a high failure rate in women who are HIV-positive.
If the abnormal tissue is not completely removed, a second treatment may be necessary. Also, the abnormal cells may recur. Both factors make it important to have regularly scheduled follow-up Pap smears and screening exams.

Other treatment options may be available for your condition. Discuss all options, including the risks and benefits, with your doctor.


Pregnancy-specific information
The safety of this procedure during pregnancy has not been established. If you've had the procedure prior to pregnancy, be sure to tell your doctor. In some cases, it seems to be associated with cervical incompetence, which can result in miscarriage or preterm birth.

Senior-specific information
The risk of developing cervical cancer increases with age. Half of all cervical cancer fatalities occur in women over age 65. Discuss with your doctor the Pap screening schedule that's best for you based on your risk factors.