What is a LEEP Procedure Done For?

To understand what a LEEP procedure is done for, it is necessary to first understand what a LEEP procedure is.

LEEP is the acronym for Loop Electrosurgical Excision Procedure, also known as large loop excision of the transformation zone (LLETZ). As the name suggests, it is a procedure in which low voltage electrical current is used to heat a wire loop to excise or remove dysplastic cells or tissues of the cervix or vagina. LEEP is more popular as it is simpler, inexpensive and has less risks and side-effects compared to CO2 laser or cryocautery. Also it might be used to further analyze the obtained abnormal tissue sample.

LEEP is used to diagnose and treat dysplastic changes in the cervix. It is usually done when the Pap (Papanicolaou) smear is found to be abnormal. Pap smear is the screening test for cervical cancer in females. LEEP is used to excise moderate to severe dysplasia and also sometimes to remove localized non-invasive cancer. LEEP can also be used to diagnose and treat polyps, genital warts which are usually due to HPV (human papilloma virus) and to detect diethylstilbestrol (DES) exposure (found in women whose mother took DES during pregnancy).

LEEP usually takes around 10 to 20 minutes. In most of the cases, it can be done in doctor’s office itself. The patient is awake during the whole procedure, but might feel mild discomfort. The patient will be asked to lie back in an examination table and the feet will be rested in stirrups. A speculum will be inserted into the vagina for proper visualization of cervix. Also a colposcope will be placed at the opening of the vagina for magnification of the cervical tissues. The suspected cervical area will be cleaned and a special solution (acetic acid or iodine) will be applied to the area of concern to make the abnormal area more visible. Local anesthesia will be used to numb the area to minimize the discomfort. A low voltage current is passed through the loop wire to remove the abnormal cells from the cervix. This might cause a little pressure or cramp in the area. After removing the dysplastic tissue, a topical medication will be applied to the affected area to stop bleeding.

In some patients, the mild pain or cramping can be expected for the first few hours after the LEEP procedure. The doctor will prescribe oral pain medication for that. There also might be dark vaginal discharge and/or spotting for few days after the procedure.

The doctor will give instructions for home care. The doctor will advise to avoid sexual intercourse for few weeks, using tampons, douching, strenuous activity and heavy lifting for better and fast healing of the excision site. It is best advised to avoid OTC pain medications such as aspirin as it might increase the chance of bleeding and only take pain medication prescribed by the doctor.

The complications after a LEEP procedure are rare and happen only in 1 to 2% of the cases. The risks include heavy bleeding, infection of cervix or uterus, scarring or changes in the cervical area of the tissue removal, narrowing of the cervical opening, trouble getting pregnant, risk for preterm birth of the baby.

The patient should immediately call her doctor if she feels generally unwell with fever and/or chills, severe pain in lower abdomen, heavy bleeding that is usually more than expected blood with clots in it, foul smelling discharge from the vagina.

The effectiveness of LEEP has been comparable to cryotherapy, cold knife conization, and laser ablation or laser conization. All these methods include either surgical removal of the abnormal tissue or destruction of the abnormal or precancerous cervical tissue. LEEP as well as other procedures have been used to treat dysplasia, precancerous or cancerous cervical tissue. After successful LEEP, regular Pap smear-follow up is necessary to evaluate for any possible recurrence of cervical tissue abnormality.