Loop electrosurgical excision procedure (LEEP)

Loop electrosurgical excision procedure or LEEP is performed to diagnose and treat abnormal cells and tissues of the cervix and vagina. Cervix is the lowermost part of the womb (uterus), that connects the vagina (also known as birth canal) to the uterus. Presence of abnormal cells on the cervix is called cervical dysplasia. These cells may not be cancerous; however, they may eventually worsen and increase your chances of cancer if not treated. Therefore, the surgeon may use a loop (of thin wire) to pass an electric current to remove these cells and allow the growth of healthy cells in the area. The cells are then sent to the laboratory to check for the presence of cancer.

This surgery is recommended to those who have cervical dysplasia or it is done to detect vaginal cancer or cervical cancer. Some of the conditions that are tested for and treated using this procedure are as follows:

• Non-cancerous growth (polyps)
• Exposure to diethylstilbestrol medication that increases the risk of cancer of the reproductive system (this can occur in a woman whose mother was exposed to this medicine during her pregnancy) 
• Genital warts (this condition indicates human papillomavirus/HPV infection that increases your risk of cervical cancer)

You may generally have no symptoms in cervical dysplasia and HPV infection. However, symptoms of cervical cancer occur when the abnormal cells become cancerous and attack the surrounding tissue. These include:

• Abnormal bleeding during periods 
• Bleeding after sexual intercourse, pelvic (lower abdominal area) examination, or douching (cleaning the outer part of the vagina with water or other mixes of liquids) 
• Pain during sexual intercourse
• Bleeding after menopause 
• Heavy periods that may last longer than usual (more than seven days)
• Increased vaginal discharge

A surgeon may not perform this procedure under the following conditions:

• Allergy to the anaesthetic used during surgery 
• Pregnancy 
• Blood-clotting disorder 
• Severe cervicitis (swelling of the cervix)
• Adenocarcinoma 
• Invasive cancer (in this condition, surgery can be performed but with caution)

Before undergoing this procedure, you will need the following preparations:

• Your healthcare provider may perform a Pap test (to detect abnormalities in the cervix and vagina) or a colposcopy (a device called colposcope just like a microscope will be used to see the cervix) and a biopsy may be done to confirm cervical dysplasia.
• He/she will carefully study your medical history and ask about allergies to any medicine or surgical components like iodine, tape, or latex.
• Tell your doctor about all the medicines that you take, including prescribed or non-prescribed medications, herbs, minerals, vitamins, and supplements. 
• Stop taking blood-thinning medications like aspirin for at least two weeks before the procedure.
• Fasting will not be required before this procedure.
• Notify your healthcare provider if you are or may be pregnant. 
• Refrain from sexual intercourse, douching, using tampons or vaginal creams one day before this procedure.
• Arrange for a friend or family member to give you a ride home after the procedure.
• If you agree to LEEP, you will need to sign an approval or consent form.
• Bring sanitary pads for use afterwards.
• You will have to take painkillers at least 30 minutes before this procedure.

After completing your admission procedure, 

• You will have to change your clothes (either entirely or only from the waist) and wear a hospital gown. 
• You will be asked to urinate to empty your bladder and lie on the operating table with your legs supported over a footrest. 
• The healthcare provider will insert a speculum (tool) inside your vagina to widen your vaginal walls and access your cervix. 
• He/she will clean your cervix and soak it in a vinegar solution to highlight and improve the visibility of the abnormal cells. 
• The surgeon will place a colposcope at your vaginal opening to see inside your cervix. 
• He/she may use a tenaculum (a type of forceps) to keep your cervix steady.

You will be given local anaesthesia (medication to numb the surgical area). Thereafter, the surgeon will perform LEEP in the following manner:

• The surgeon will insert an electrosurgical loop inside your cervix through the speculum. He/she may use multiple loops to access deeper inside your cervix. 
• As the loop is passed, it cuts a thin film of tissue, allowing the removal of abnormal cells. The quantity and location of tissue may vary, depending on the usage of LEEP for diagnostic and treatment purposes. 
• The surgeon will seal the blood vessels in the area with an electric current to reduce the chances of bleeding after the procedure. 
• He/she may apply a medicinal paste on the operated region to stop bleeding from the cervix. 
• Lastly, your cells will be sent to the laboratory for testing.

It may take about 10 to 20 minutes to complete this procedure. You may be allowed to go home right after.

After this procedure, you will be asked to take care of yourself in the following manner at home:

• Medications: Your doctor may prescribe pain medicines to reduce your cramping or soreness after the procedure. Take only the medications that are recommended.
• Bleeding: 
  • You may experience spotting, cramping, and black-coloured discharge for one to three weeks after this procedure. This discharge may occur due to the medicine used for stopping bleeding.
  • Sanitary napkins can be used for bleeding. Avoid wearing tampons for at least four weeks after LEEP.
  • You may experience a change in your period flow for a few months after this procedure. For example, the period just after the procedure may be heavier than the normal.
• Bathing/shower: 
  • You may be allowed to take a shower after this procedure.
  • Avoid soaking in the bathtub or swimming for at least four weeks.
• Activities:
  • Avoid douching or having sex for four weeks after the surgery.
  • Do not perform strenuous activities or lift heavy objects for the initial two weeks after the procedure.
  • Slowly proceed with your activities. If you experience bleeding other than your regular periods, stop that activity for a few days.

When to see the doctor?

Notify (call or visit) your healthcare provider immediately if you experience the following symptoms after this procedure:

• Heavy bleeding 
• Fever 
• Foul smell with discharge from the operated area 
• Severe abdominal pain 
• Bleeding with clots

This procedure is known to carry the following risks:

• Contractions of the cervix
• Scarring of the cervix tissue
• Bleeding
• Trouble in future pregnancies (having a preterm or low birth weight baby)
• Incomplete removal of the abnormal tissues
• Abdominal cramping 
• Infection
• Accidental burning or cutting of normal tissues

You will have a follow-up appointment two to four weeks after LEEP to examine the healing of your cervix. Also, you will have to undergo a Pap smear test again four months after the procedure.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.