• Piedmont Women's Healthcare

LEEP for abnormal cervical cell changes
The loop electrosurgical excision procedure (LEEP) uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. LEEP can:

• Cut away abnormal cervical tissue that can be seen during colposcopy.
• Remove abnormal tissue high in the cervical canal that cannot be seen during colposcopy.

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

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

How it is performed
LEEP is usually performed at a health professional's office, a clinic or a hospital as an outpatient procedure.

The patient takes off their clothes below the waist and drapes a paper or cloth covering around the waist. The patient lies on their back on an examination table with their feet raised and supported by footrests (stirrups). The health professional inserts an instrument with curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined.

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

What to expect after surgery
Most women are able to return to normal activities within one to three days after LEEP is performed. Recovery time depends on how much was done during the procedure.

After LEEP

• Mild cramping may occur for several hours after the procedure.
• A dark brown vaginal discharge during the first week is normal.
• Vaginal discharge or spotting may occur for about three weeks.
• Sanitary napkins should be used instead of tampons for about three weeks.
• Sexual intercourse should be avoided for about three weeks.
• Douching should not be done.

When to call your health professional
Contact the health professional if any of the following symptoms occur:

• A fever.
• Spotting or bleeding that lasts longer than one week.
• Bleeding that is heavier than a normal menstrual period.
• Increasing pelvic pain.
• Bad-smelling, yellowish vaginal discharge, which may indicate an infection.

Why it is performed
LEEP is performed after abnormal Pap test results have been confirmed by colposcopy and cervical biopsy. LEEP may be used to treat:

• Minor cell changes called low-grade squamous intraepithelial lesions (LSIL) that may be precancerous and that persist after a period of watchful waiting.
• Moderate to severe cell changes that can be removed.

How well it works
LEEP is a very effective 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 for cancer that has grown deep into the cervical tissue. In this way, LEEP can help further diagnosis as well as treat the abnormal cells.

LEEP is as effective as cryotherapy or laser treatment. If all of the abnormal cervical tissue is removed, no further surgery is needed, though abnormal cells may recur in the future.

Risks

• After the surgery, a small number of women (less than 10%) may have significant bleeding that requires vaginal packing or a blood transfusion.
• Infection of the cervix or uterus may develop (rare).
• Narrowing of the cervix that can cause infertility may occur (rare).
• Once a woman has had LEEP, she has a higher risk of delivering a baby early.

What to think about
LEEP is less expensive and easier to perform than cone biopsy or carbon dioxide laser treatment.

A biopsy is performed to confirm the abnormal cervical cell changes before a LEEP procedure is performed.

If you have LEEP, you need regular follow-up Pap tests. A Pap test should be repeated every four to six months or as recommended by a health professional. Once several Pap test results are normal, you and the health professional can decide how often to schedule future Pap tests.