LEEP procedure is also known as loop electrosurgical excision procedure or large loop excision of the transformation zone (LLETZ). In LEEP procedure, a low voltage current is passed through a wire to heat it which is used to excise and cauterize the abnormal tissue in cervical dysplasia.
Cervical cancer affects millions of women around the world and is amongst the leading cancers in women. It is caused by HPV (human papilloma virus) that is found in 99% cases of cervical cancers, so there are different modalities to prevent cervical cancer. HPV vaccines are given to women up to age 26 to prevent cervical cancer, also routine Pap screening should start at the age 21 for cervical prevention. If the Pap smear including biopsy is positive for precancerous condition then different treatment modalities are used to treat them and to avoid cervical cancer. The most popular among those treatment modalities is loop electrosurgical excision procedure, known as LEEP procedure.
LEEP is not only popular because it is simple, effective and inexpensive, but because it has less post procedure risks and side-effects which also includes less risk with fertility. Thus, a woman can have a healthy baby after she has had LEEP procedure.
What is LEEP Procedure?
LEEP is a procedure that is used to treat precancerous conditions of cervix, vulva or vagina. LEEP is done usually after an abnormal Pap smear; it is used as a diagnostic as well as a treatment modality. It is an office procedure and does not take more than 30 minutes for the completion of the procedure. It is done under local anesthesia and does not require any general anesthesia to perform it, so it is less concerning.
The patient lies in supine position with legs resting in stirrups similar to a pelvic exam. A speculum is inserted into the vagina to visualize it properly. A colposcope may also be used for better magnification and illumination of the vaginal and cervical tissues. An acetic acid and/or iodine solution is then applied to the area of concern that highlights the area of abnormal tissues. A low voltage current is used through a wire, which is heated and then used to excise the abnormal tissue from the cervix. This might be a little uncomfortable, so local anesthesia might be used to anesthetize the area. The bleeding will be achieved with the cautery during the LEEP procedure and in addition a hemostatic solution is applied to stop any remaining bleeding.
There might be some complications after LEEP procedure that includes heavy bleeding, pain, infection of cervix or uterus, scarring or stenosis of the cervical opening. These risks are rare and only happen in 1% of cases. There is also a concern of preterm birth of a baby and possible second trimester miscarriage. However, this is rare and is only associated with removal of large portions of dysplastic cervical tissue. The patient should weigh both the benefits and risks of the procedure before proceeding with it. It should be kept in mind that it is the treatment of cervical dysplasia, which left untreated will lead to cervical cancer.
Can You Have A Baby After a LEEP Procedure?
There have been various studies that suggest women getting pregnant before 12-month interval of LEEP are at greater risk of miscarriage, which is around six fold. The ones who wait for a period of 12 months or longer to get pregnant are less likely and have a reduced chance of miscarriages. LEEP is; however, preferred over cold knife conization which has a greater morbidity rate.
The decision to carry forward with excision or ablative procedure depends on various factors including the reproductive age, severity of pre-cancer and the decision or desire to bear children in future.
There is limitation in studies that suggest that fertility of a woman is affected after pre-cancer treatment, although the rate of miscarriages in the second trimester did increase. There is an increased risk of preterm birth and this risk increases with the increased depth of the excision. There has also been an increase in higher pregnancies in women who have been treated with cervical pre-cancers and have successfully given birth to a healthy child.
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