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 a neck-like structure that connects the vagina and uterus. LEEP is done to remove abnormal cervical cells.
Reasons for Procedure
LEEP is often done after abnormal
cells have been found on the cervix. These abnormal cells are often found on a
. If the cells found on a Pap test show
(abnormal cells) or cancer cells, a LEEP may be done.
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
and having a low birth weight baby)
- Narrowing of the cervix (very rare)
- Incomplete removal of the abnormal tissue
- Accidental cutting or burning of normal tissue
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
- Chronic disease such as diabetes or obesity
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.
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 one 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 right 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. The doctor will insert a speculum into your vagina. This tool will separate the vaginal walls. This will allow the doctor to see the cervix. Anesthesia will be applied to the cervix to numb the area.
The doctor will then apply a solution to the cervical area. The solution will show the abnormal area that needs to be removed. The doctor will insert a thin wire into the vagina toward the cervix. You will hear a vacuum-like noise. You may also hear a humming noise. The thin wire loop is like a surgical knife. The doctor will be able to gently remove the abnormal tissue. You will need to stay very still. The doctor will cauterize the area. 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
- Keeping your incisions covered
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
- Not allowing others to touch your incisions
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:
- Rest when you get home.
- Frequently change the sanitary pad.
- Take pain medicine as directed.
It will take a few weeks for your cervix to heal. For four 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 six 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 medical help right away.
American Congress of Obstetricians and Gynecologists
Family Doctor—American Academy of Family Physicians
Canadian Women’s Health Network
Society of Obstetricians and Gynaecologists of
American Congress of Obstetricians and Gynecologists. Management of abnormal cervical cytology and histology.
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). American Congress of Obstetricians and Gynecologists website. Available at:
http://www.acog.org/Patients/FAQs/Loop-Electrosurgical-Excision-Procedure-LEEP. Updated July 2014. Accessed August 15, 2014.
Loop electrosurgical excision procedure (LEEP). American Society for Colposcopy and Cervical Pathology website. Available at:
http://www.asccp.org/Education/COURSES-Comprehensive-Colposcopy-HRA-Advanced-and-more/Loop-Electrosurgical-Excision-Procedure-LEEP. Accessed August 15, 2014.
Neff D. Endometrial ablation. EBSCO Health Library website. Available at:
http://www.ebscohost.com/healthLibrary. Updated January 28, 2014. Accessed August 15, 2014.
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.