Loop Electrical Excision Procedure (LEEP)

Sometimes referred to as “LEEP”, the loop electrosurgical excision procedure is a way to test and treat abnormal cell growth on the surface tissue of a woman’s cervix.  It is normally recommended after abnormal changes in the cervix are confirmed by other testing.   LEEP allows a physician to remove the abnormal tissue and, if necessary, test it for cancer.

Abnormal cells, or cervical dysplasia

The term "plasia" means growth, and dysplasia means disordered growth.   It is easier to understand cervical dysplasia if we first understand the normal cervix.   When we look at the lining of the normal cervix under a microscope we see layers of cells.  The normal distribution is that the bottom layer is made of round young cells.   As the cells mature, they rise to the surface and flatten out, so that on the surface the cells are flat.

In cervical dysplasia there is a lack of this organized growth process. In mild dysplasia only a few cells are abnormal, while in moderate dysplasia the abnormal cells involve about one-half of the thickness of the surface lining of the cervix. Severe dysplasia is diagnosed when the entire thickness of cells is disordered, but the abnormal cells have not yet spread below the surface. Untreated, this condition can result in cervical cancer.

Removing the Cells

The LEEP procedure is normally performed in the physician’s office, and begins much like a regular pelvic exam.  Though you will be awake throughout the procedure, there should be only minor discomfort.   First, you will be asked to lie back and rest your feet in stirrups at the end of the examination table. A speculum is then inserted into the vagina and opened so that the cervix can be seen.

A solution is applied to the cervix to make the abnormal cells visible. The physician then places a colposcope near the opening of the vagina. The colposcope, which remains outside of the vagina, provides a magnified view of the cervix.  The cervix is then numbed with local anesthesia, and an electrically charged loop made of thin wire is inserted through the speculum and up to the cervix. As the loop is passed across the cervix, it cuts away a thin layer of surface tissue, removing the abnormal cells.  This tissue will be later tested for cancer or abnormal cells.  Finally, a medicated paste is applied to the area to control the bleeding.

After the Procedure

Although you may dress and go home immediately after the procedure, it can take several days for your cervix to completely heal.  Some things to keep in mind are:

• You may want to wear a sanitary pad for bleeding.  It is normal to have some mild cramping, spotting, and dark or black-colored discharge for several days. The dark discharge is from the medication applied to your cervix to control bleeding.
• You may be instructed not to douche, use tampons, or have intercourse for a certain period of time, usually 3-4 weeks.
• Other restrictions for the next few weeks may include no strenuous activity or heavy lifting.
• Pain relievers for cramping or soreness should be taken only as directed by your healthcare provider.  Aspirin and certain other pain medications may increase the chance of bleeding.
• Your physician will advise you on when to return for further treatment or care. Usually, women who have had LEEP will need more frequent Pap tests.

Risks and complications 

As with any surgical procedure, complications such as infection can occur.  These can be easily treated, but you should notify your healthcare provider immediately if you experience any of the following:

• bleeding with clots
• severe abdominal pain
• foul-smelling drainage from your vagina
• chills and/or fever

There are also several factors that may interfere with performing the procedure, or that the physician needs to be aware of before performing LEEP.  Tell the nurse or physician:

• If you are or may be pregnant
• If you may be menstruating during the scheduled time
• If you have any allergies or sensitivities to medications, iodine or latex
• If you have recently had a vaginal infection or pelvic inflammatory disease

Remember 

LEEP is a safe and effective way to remove abnormal cervical cells.  After the procedure, be sure to follow your healthcare provider’s instructions precisely.   Keeping the follow-up appointments is necessary to verify that all of the abnormal cervical tissues have been removed, as well as to make sure that if abnormal cervical cells redevelop they are caught early and treated appropriately.