Loop Electrosurgical Excision Procedure (LEEP)
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(Large Loop Excision of the Transformation Zone [LLETZ], Large Loop Excision of the Cervix [LLEC], Loop Cone Biopsy of the Cervix)
What is a loop electrosurgical excision procedure (LEEP)?
Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by electric current to remove cells and tissue as part of the diagnosis and treatment for abnormal or cancerous conditions in a woman’s lower genital tract.
The lower genital tract includes the cervix and vagina. The cervix is the lower, narrow part of the uterus (womb) and the vagina connects the cervix and the vulva (the external genitalia).
With LEEP, an electric current passes through the fine wire loop to cut away a thin layer of abnormal tissue. This tissue will be sent to the lab for examination. LEEP can also remove abnormal cells to allow healthy tissue to grow.
Other related procedures that may be used to diagnose cervical and vaginal conditions include Pap test, cervical biopsy, and colposcopy. Please see these procedures for additional information.
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What are female pelvic organs?
The organs and structures of the female pelvis are:
- endometrium - the lining of the uterus
- uterus - also called the womb, the uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.
- ovaries - two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored and where the female sex hormones estrogen and progesterone are produced
- cervix - the lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body
- vagina - the passageway through which fluid passes out of the body during menstrual periods. Also called the "birth canal," the vagina connects the cervix and the vulva (the external genitalia).
- vulva - the external portion of the female genital organs
- fallopian tubes - two thin tubes that extend from each side of the uterus, toward the ovaries as a passageway fro eggs and sperm.
LEEP may be performed when cervical or vaginal problems are found during a pelvic examination, or abnormal cells are found during a Pap test. LEEP is also performed to detect cancer of the cervix or vagina.
Cells that appear to be abnormal, but are not cancerous at the present time, may be identified as precancerous. The appearance of these abnormal cells may be the first evidence of cancer that could develop years later.
LEEP may also be used to assist in the diagnosis or treatment of the following conditions:
- polyps (benign growths)
- genital warts, which may indicate infection with human papilloma virus (HPV), a risk factor for developing cervical cancer
- diethylstilbestrol (DES) exposure in women whose mothers took DES during pregnancy, as DES exposure increases the risk for cancer of the reproductive system
There may be other reasons for your health care provider to recommend LEEP.
As with any surgical procedure, complications may occur. Some possible complications may include, but are not limited to, the following:
- changes or scarring in the cervix from removal of tissue
- difficulty getting pregnant
- potential for preterm birth or having a low birth weight baby
Patients who are allergic to or sensitive to medications, iodine, or latex should notify their health care provider.
If you are pregnant or suspect that you may be pregnant, you should notify your health care provider.
There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your health care provider prior to the procedure.
Certain factors or conditions may interfere with LEEP. These factors include, but are not limited to the following:
- acute pelvic inflammatory disease
- acute inflammation of the cervix
- Your health care provider will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
- You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
- Generally, no prior preparation, such as fasting or sedation, is required.
- If you are pregnant or suspect that you are pregnant, you should notify your health care provider.
- Notify your health care provider if you are sensitive to or are allergic to any medications, latex, tape, iodine, and anesthetic agents (local and general).
- Notify your health care provider of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
- Notify your health care provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
- Your health care provider will give you instructions as to using tampons, vaginal creams or medications, douching, or having sexual relations before the procedure.
- LEEP is usually performed when you are not having your menstrual period.
- Your health care provider may recommend that you take a pain reliever 30 minutes before the procedure.
- You may want to bring a sanitary napkin to wear home after the procedure.
- Based upon your medical condition, your health care provider may request other specific preparation.
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LEEP may be performed in a health care provider's office, on an outpatient basis, or as part of your stay in a hospital. Procedures may vary depending on your condition and your health care provider's practices.
Generally, LEEP follows this process:
- You will be asked to undress completely or from the waist down and put on a hospital gown.
- You will be instructed to empty your bladder prior to the procedure.
- You will lie on an examination table, with your feet and legs supported as for a pelvic examination.
- Your health care provider will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
- Often, the health care provider will use a colposcope, an instrument with a special lens similar to a microscope, to magnify the tissues. The colposcope will be placed at the opening of your vagina but does not enter your vagina.
- Your health care provider will look through the colposcope to locate any areas for treatment on the cervix or in the vagina. Photographs with the colposcope or sketches of the areas on your cervix may be made for your healthcare record.
- Your cervix may be cleansed and soaked with a vinegar solution, also called acetic acid solution. This helps make the abnormal tissues turn white and become more visible. You may feel a mild burning sensation. An iodine solution is sometimes used to coat the cervix, called the Schiller test.
- The health care provider will numb the area using a small needle to inject medication.
- A type of forceps, called a tenaculum, may be used to hold the cervix steady for the procedure. You may feel some cramping when the tenaculum is applied.
- You will hear humming and/or blowing sounds from the equipment.
- The LEEP wire will be inserted through the speculum and passed through the abnormal tissues. One or more passes may be needed. You may feel pressure or a slight cramping.
- Some women feel faint during the procedure. Tell your health care provider or the nurse if you have this feeling.
- It is very important that you lie still during the procedure.
- The amount and location of tissue removed depends on the whether LEEP is being used as a diagnostic tool, or to remove abnormal tissue. LEEP wires come in different sizes and shapes.
- The electrical current will act as a cautery to seal the blood vessels, so usually there is very little bleeding. Any bleeding from the LEEP site may be treated with a paste-like topical medication.
- The tissue will be sent to a lab for further examination.
After LEEP, you may rest for a few minutes after the procedure before going home.
You may want to wear a sanitary pad for bleeding. It is normal to have some mild cramping, spotting, and dark or black-colored discharge for several days. The dark discharge is from the medication applied to your cervix to control bleeding.
You may be instructed not to douche, use tampons, or have intercourse for four weeks after LEEP, or for a period of time recommended by your health care provider.
You may also have other restrictions on your activity, including no strenuous activity or heavy lifting.
Take a pain reliever for cramping or soreness as directed by your health care provider. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
Your health care provider will advise you on when to return for further treatment or care. Generally, women who have had LEEP will need more frequent Pap tests.
Notify your health care provider if you have any of the following:
- bleeding with clots
- foul-smelling drainage from your vagina
- fever and/or chills
- severe abdominal pain
Your health care provider may give you additional or alternate instructions after the procedure, depending on your particular situation.