LEEP (Loop Electrosurgical Excision Procedure)

(also known as LLETZ (Large Loop Excision of the Transformation Zone)

What is a LEEP?

LEEP is the treatment of choice for women with persistent mild, moderate, or severe dysplasia of the cervix (see colposcopy section). A wire loop that cuts and cauterizes tissue is used to scoop out the area of the cervix that contains abnormal cells. LEEP procedures are performed in our office using local anesthesia. Complications such as infection, bleeding, and damage to the cervix are possible, but occur at a very low rate. Cure rates are generally in the 85 to 90% range, depending on the size of the abnormal area and the type of dysplasia present. In addition to treating dysplasia, LEEP is used for diagnostic purposes if the problem area can't be seen on colposcopy.

WHAT you should do to prepare

No special preparation is needed. 400-600 mg of ibuprofen around one hour prior to the procedure will alleviate cramping. Do not fast. Do not schedule the procedure when you are menstruating.

WHAT to expect during the procedure

After you are brought to the examination room, you will be asked to undress from the waist down. The LEEP machine uses electrocautery, so a pad will be applied to your leg to "ground you" and prevent any shock during the procedure. This is a safety device, and the LEEP machine will not even turn on unless the pad has been properly applied. If the pad were to come off, the machine automatically turns off, ensuring that there is no chance of you experiencing any electrical shock. A non-metal speculum is placed in the vagina, and acetic acid (vinegar) is placed on the cervix to enhance visualization. This will feel cold and wet and smell like vinegar, but otherwise has no effects. The physician will then look at your cervix using the colposcope in order to get a magnified view so that she can see the area with abnormal cells. Local anesthesia will be injected into the cervix in order to numb the area. When the local is injected, some women are aware of a momentary pinch or cramp, but some women feel nothing. The local anesthesia also contains a small amount of epinephrine to constrict cervical blood vessels and eliminate bleeding (this is the same solution that the dentist uses in your mouth). Some women experience a racing heart, ringing in the ears, or a metallic taste in the mouth. If you experience any of these symptoms, it is nothing to be concerned about and will pass in a few minutes, but let your doctor know what you are experiencing.

Once your cervix is completely numb, a wire loop is used to scoop out the abnormal tissue. During this part of the procedure, you will hear two noises: the LEEP machine making a soft buzzing sound and a smoke evacuator making a vacuum-like sound (the cautery produces a small amount of smoke and it must be sucked away during the procedure so we can see your cervix clearly). You will not feel any pain but may be aware of slight pressure or warmth. Once the LEEP is completed, the doctor will apply Monsels paste (a mustard-like medication) to the cervix to prevent any bleeding.

No stitches are needed, and the tissue heals beautifully within a few weeks. The specimen is sent to a pathologist for evaluation to determine if all the abnormal tissue has been removed.

The entire procedure takes approximately 15 minutes.

WHAT to expect after the procedure

Most women feel fine immediately after the procedure and can return to their daily routine. Some women feel lightheaded. If that is the case, tell your doctor and she will have you rest in the procedure room until the feeling passes. Some women experience cramping, but it is unusual for the cramping to be severe. Some bleeding is expected, but it is usually minimal. You may use a pad. The medication applied to your cervix is called Monsels paste and looks like dark mustard or peanut butter. It may come out at a day or two after the procedure and is sometimes blood-tinged or dark and crusty.

Refrain from intercourse for two weeks. Refrain from high impact exercise for at least 2-3 days.

RESULTS

The tissue is sent to Northwestern Memorial Hospital to be evaluated by the pathologist. Results take approximately one week. Your doctor will call you as soon as results are received. If you have not heard in one week, please contact us. Your doctor will tell you when to have a follow-up Pap smear .

FAQ

How long does colposcopy with LEEP take?
The procedure usually takes 10-15 minutes.

What if I am bleeding at the time of the procedure?
This procedure should be done when you are not menstruating. If you are having continuous bleeding or spotting (non-menstrual), check with your doctor about the best time to have your colposcopy.

What if I have a tendency to pass out?
Some women do get light-headed or pass out during any gynecologic procedure. If this is the case, please be sure to EAT PRIOR TO YOUR ARRIVAL. Inform your doctor that you have a tendency to faint. If, during the procedure, you feel light-headed, nauseated, or ill, tell your doctor immediately.

Can I have a friend or relative accompany me?
Yes, you may have one visitor. No children are allowed in the procedure room.

I am worried about the pain. Can I have anesthesia or sedation for the procedure?
The cervix is completely numbed and it is unusual for women to be aware of any significant pain. Most women report that the LEEP procedure was actually easier than their colposcopy and biopsy. Having said that, some women prefer to feel nothing and we are happy to have our in-office anesthesia team provide sedation. This must be scheduled in advance, so please speak to your doctor or the scheduler if you are interested in this option.

How much bleeding is too much?
Bleeding after a LEEP is usually minimal. If you are experiencing a heavy menstrual-like flow or bright red bleeding that is soaking a pad, call immediately. A crusty, thick, slightly bloody discharge is normal and is no cause for concern.