The loop electrosurgical excision procedure (LEEP) uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. LEEP can:
- Cut away abnormal cervical tissue that can be seen during colposcopy .
- Remove abnormal tissue high in the cervical canal that cannot be seen during colposcopy. In this situation, LEEP may be done instead of a cone biopsy.
LEEP is also known as large loop excision of the transformation zone (LLETZ).
A vinegar (acetic acid) or iodine solution, which makes abnormal cells more visible, may be applied to the cervix before the procedure is done.
How it is done
LEEP is usually done at your doctor's office, a clinic, or a hospital as an outpatient procedure. You do not have to spend a night in the hospital.
You will need to take off your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie on your back on an exam table with your feet raised and supported by footrests (stirrups). Your doctor will insert a lubricated tool called a speculum into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined.
Medicine is injected to numb the cervix (cervical block). If a cervical block is used, an oral pain medicine or pain medicine given into a vein (intravenous, or IV) may be used along with the local anesthetic.
What To Expect After Surgery
Most women are able to return to normal activities within 1 to 3 days after LEEP is performed. Recovery time depends on how much was done during the procedure.
- Mild cramping may occur for several hours after the procedure.
- A dark brown vaginal discharge during the first week is normal.
- Vaginal discharge or spotting may occur for about 3 weeks.
- Pads should be used instead of tampons for about 3 weeks.
- Sexual intercourse should be avoided for about 3 weeks.
Douching should not be done.
When to call your doctor
Call your doctor now or seek immediate medical care if:
- You have severe vaginal bleeding. You are passing clots of blood and soaking through your usual pads each hour for 2 or more hours.
- You have pain that does not get better after you take pain medicine.
- You have signs of infection, such as:
- Increased pain.
- Vaginal discharge that smells bad.
- A fever.
Why It Is Done
LEEP is done after abnormal Pap test results have been confirmed by colposcopy and cervical biopsy. LEEP may be used to treat cell changes on the cervix. These include:
- Minor cell changes called low-grade squamous intraepithelial lesions (LSIL) that may be precancerous and that persist after a period of watchful waiting.
- Moderate to severe cell changes that can be removed.
How Well It Works
LEEP is a very effective treatment for abnormal cervical cell changes. During LEEP, only a small amount of normal tissue is removed at the edge of the abnormal tissue area.
After LEEP, the tissue that is removed (specimen) can be examined for cancer that has grown deep into the cervical tissue (invasive cancer). In this way, LEEP can help further diagnosis as well as treat the abnormal cells.
LEEP is as effective as cryotherapy or laser treatment. If all of the abnormal cervical tissue is removed, no further surgery is needed, though abnormal cells may recur in the future. In some studies, all the abnormal cells were removed in as many as 98% of cases.1
- Infection of the cervix or uterus may develop (rare).
- Narrowing of the cervix (cervical stenosis) that can cause infertility may occur (rare).
- After a woman has had LEEP, she has a higher risk of delivering a baby early.2
What To Think About
Loop electrosurgical excision procedure (LEEP) is less expensive and easier to perform than cone biopsy or carbon dioxide laser treatment.
Before a LEEP procedure is done, a biopsy is done to confirm the abnormal cervical cell changes.
If you have LEEP, you need regular follow-up Pap tests. A Pap test should be repeated every 4 to 6 months or as recommended by your doctor. After several Pap test results are normal, you and your doctor can decide how often to schedule future Pap tests.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Garcia F, et al. (2012). Intraepithelial diseases of the cervix, vagina, and vulva. In JS Berek, ed., Berek and Novak's Gynecology, 15th ed., pp. 574-618. Philadelphia: Lippincott Williams and Wilkins.
Samson SA, et al. (2005). The effect of loop electrosurgical excision procedure on future pregnancy outcomes. Obstetrics and Gynecology, 105(2): 325-332.
Primary Medical ReviewerSarah Marshall, MD - Family Medicine
Specialist Medical ReviewerKirtly Jones, MD - Obstetrics and Gynecology
Current as ofMarch 12, 2014