LEEP Procedure

What does it mean?

LEEP are the initials for Loop Electrosurgical Excision Procedure.

This procedure is also referred to as LLETZ (Large Loop Excision of the Transformation Zone). It is the excision of the transformation zone tissue by using an electrical loop.

The Loop is made of a thin wire, with a high-frequency current running through it. Thanks to the current running through it, the wire loop cuts through the tissue and removes it.

Does the LEEP procedure require general anesthesia?

No general anesthesia is required normally, because the procedure is usually well-tolerated with local anesthesia. General anesthesia is administered when there are anatomical particularities (e.g. a displaced cervix), and access to the surgical field is difficult. Also, in cases where the lesions cover a large area and extend to the vaginal vaults or when curettage is also necessary.

How is the procedure performed?

  • The patient lies in the gynecological examination position.
  • The doctor inserts the speculum into the vagina (like when performing a Pap test) and opens the vaginal walls to have visual access to the surgical field. He cleans the vagina with normal saline and antiseptic solution.
  • The doctor then inspects the cervix through the colposcope, after using an acetic acid solution, and if necessary, an iodine solution called ‘lugol’. He identifies the lesion areas and the transformation zone, i.e. the part of the tissue that must be removed.
  • Local anesthesia is performed on the cervix, using a thin dental needle.
  • The loop size is chosen, depending on the anatomical position of the lesions and the size of the transformation zone.
  • The loop is connected with the electrodiathermy machine and the current is activated by the doctor as the loop moves, dissects and removes the tissue.
  • The tissue with the lesions is usually removed in one go, i.e. by passing the loop once over it. However, in patients with extensive lesions, a second passage of the loop may be required.
  • After the tissue is removed, the bleeding areas are identified and cauterized with electrodiathermy. The procedure does not require hospitalization of the patient. Hospitalization is required only in a few highrisk cases, when the doctor deems it necessary.

What are the complications and risks of a LEEP procedure?

Complications after a LEEP procedure are not frequent (they occur in <10% of cases). According to the informational leaflet of the American Society for Colposcopy and Cervical Pathology (ASCCP), which is given to patients before a procedure, the following complications are possible:

  • Heavy bleeding
  • Bleeding with clots
  • Severe abdominal pain described as a cramp
  • Fever
  • Vaginal odorous discharge – Post-op inflammation
  • Occasional cutting or burning of normal tissue
  • Imperfect removal of infected tissue
  • Stenosis of cervical opening after the procedure

The ASCCP patient information leaflet also mentions that the patient must inform the doctor if, after leaving the hospital, she has any of the following:

  • Bleeding (blood quantity greater than a period or clots)
  • Fever
  • Yellow vaginal pus-like discharge, or odorous discharge.

If she can’t find her doctor, the patient must go to the ER.

Post-operative instructions

After the procedure, a painkiller is recommended. To prevent any post-operative bleeding or inflammation, you must do the following for 4 weeks:

  • Don’t lift weights heavier than 5-6 kg.
  • No sexual contact.
  • Do not insert anything into your vagina (tampons, vaginal douche, fingers, vibrators, etc).

What are the future risks after a LEEP procedure?

Apart from the small chance of stenosis of the cervical opening, it has been observed that the removal of large parts of the cervix contributes to an increase in the frequency of premature labor in future pregnancies. The increase is small if the procedure is performed once and the volume of the removed tissue does not exceed 25% of the total volume of the cervix. It increases, however, in those cases where large parts are removed or a second LEEP is done.