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Loop Electrosurgical Excision Procedure
(LEEP, LLETZ—Large Loop Excision of the Transformation Zone, LLEC—Large Loop Excision of the Cervix, Loop Cone Biopsy of the Cervix)
Loop electrosurgical excision procedure (LEEP) uses a thin wire loop to precisely cut out areas of the cervix. The cervix is the lowest part of the uterus and . LEEP is done to remove abnormal cervical cells.
Reasons for Procedure
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Abdominal cramping
- Future pregnancy problems (small increased risk of premature birth and having a low birth weight baby)
- Incomplete removal of the abnormal tissue
- Accidental cutting or burning of normal tissue
- Narrowing of the cervix (rare)
If there is time before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
The following may also increase the risk of complications:
- Menstruation at the time of the procedure—It is best to have LEEP done when you do not have your period.
- History of pelvic inflammatory disease
- Inflammation of the cervix
- Pregnancy or possible pregnancy
What to Expect
Prior to Procedure
Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.
The day of the procedure:
- If your doctor will be giving you a sedative, arrange for someone to drive you home from the clinic.
- If directed by your doctor, take a pain reliever before the LEEP.
- Bring sanitary napkins to use after the procedure.
Local anesthesia is often used for a LEEP. This will keep you from feeling pain during the procedure. You will be awake during the procedure. The anesthesia may be applied with a lotion or injected into the area.
Description of the Procedure
You will lie on your back on a table with your feet up in footrests. A speculum will be inserted into your vagina. This tool will separate the vaginal walls. This will allow the cervix to be viewed. Anesthesia will be applied to the cervix to numb the area.
A solution will be applied to the cervical area to show the abnormal area that needs to be removed. A thin wire will be inserted into the vagina toward the cervix. The abnormal tissue will be removed with the thin wire. The area will be cauterized. This process heats the blood vessels to stop bleeding. A paste may also be applied to stop bleeding.
How Long Will It Take?
LEEP only takes a few minutes.
How Much Will It Hurt?
You may feel cramping during LEEP. You should not feel any sharp pain.
At the Care Center
Your blood pressure and heart rate will be checked.
During your stay, the care center staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
There are also steps you can take to reduce your chances of infection such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
After the procedure, you may have:
- Dark brown-black vaginal discharge for several days
- Mild cramping
- Watery pink discharge
When you return home, do the following to help ensure a smooth recovery:
It will take a few weeks for your cervix to heal. For 4 weeks:
- Do not use tampons or douches.
- Refrain from sexual intercourse.
- Do not do any heavy lifting.
- It is okay for you take baths and showers.
- If advised by your doctor, have a Pap test and pelvic exam every 6 months.
Call Your Doctor
After arriving home, contact your doctor if any of the following occurs:
- Heavy bleeding (more than your normal period)
- Bleeding with clots
- Severe abdominal pain
- Fever or chills
- Unusual odor or discharge
If you think you have an emergency, call for emergency medical services right away.
The American Congress of Obstetricians and Gynecologists
Family Doctor—American Academy of Family Physicians
Canadian Women’s Health Network
The Society of Obstetricians and Gynaecologists of Canada
American Congress of Obstetricians and Gynecologists. Management of abnormal cervical cytology and histology. Practice Bulletin. 2010; 99.
Emam M, Elnasar A, Shalen H, Barakat R. Evaluation of a sinfle-step diagnosis and treatment of premalignant cervical lesions by LEEP. Int J Gynaecol Obstet. 2009;107(3):224-7.
Loop electrosurgical excision procedure (LEEP). The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/Patients/FAQs/Loop-Electrosurgical-Excision-Procedure-LEEP. Updated July 2017. Accessed September 11, 2017.
Noehr B, Jensen A, Kjaer SK. Depth of cervical cone removal by loop electrosurgical excision procedure and subsequent risk of preterm delivery. Obstet Gynecol. 2009;114(6):1232-8.
- Reviewer: EBSCO Medical Review Board Beverly Siegal, MD, FACOG
- Review Date: 09/2018
- Update Date: 01/28/2014