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LEEP, loop electrosurgical excision procedure

Alternative Names 
large loop excision of the transformation zone (LLETZ), loop excision of the transformation zone (LETZ)

LEEP, or loop electrosurgical excision procedure, is the removal of a piece of the cervix, which is the neck of the uterus. This is done by passing electricity through a thin loop of wire, which cuts and seals the tissue being removed.

Who is a candidate for the procedure? 
This procedure is done on women whose Pap smears show abnormal changes in the cells of the cervix. These changes may lead to cancer. The most appropriate candidates for LEEP are women with so-called high-grade changes, which represent very disorganised areas of tissue in the cervix.

LEEP is not done on women who have cancer that has already invaded the cervix.

How is the procedure performed? 
LEEP only takes a few minutes. Usually, it is done in the office of a doctor. Some women and doctors prefer the procedure to be performed under general anaesthesia.

First, the cervix is injected with a local anaesthetic and medication that makes the blood vessels contract to avoid blood loss. The wire loop is then passed across the cervix. It removes the area between the outer and inner portion of the cervix, which is called the transformation zone. Most cervical problems develop in this area.

The wire loop cuts and seals the tissue it passes through. The size of the piece removed depends on the size of the wire loop used.

The tissue sample is then sent to the laboratory to be examined under the microscope.

What happens right after the procedure? 
After the procedure, a woman should report severe bleeding or any other problems she has been warned of to her doctor. Other problems may include abnormal vaginal discharge, fever or severe pain. Some mild discomfort or dull pain may be present for a few days afterward.

What happens later at home? 
Douching and sexual intercourse should be avoided for at least 2 weeks or until the patient has a follow-up visit with her doctor.

What are the potential complications after the procedure? 
Bleeding and infection are the major complications of LEEP. These occur rarely.

Author: Carlos Herrera, MD
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 12/06/2005
Potential conflict of interest information for reviewers available on request

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