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)
by Deanna M. Neff, MPH
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 Pap test. If the cells found on a Pap test show cervical dysplasia (abnormal cells) or cancer cells, a LEEP may be done.
Possible Complications TOP
If you are planning to have LEEP, your doctor will review a list of possible complications, which may include:
Some factors that may increase the risk of complications include:
Be sure to discuss these risks with your doctor before the procedure.
What to Expect TOP
Prior to Procedure
In the weeks leading up to the procedure:
The day of 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 foot rests. 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. Once you are feeling okay, you will be able to go home.
After the procedure, you may have:
When you return home, do the following to help ensure a smooth recovery:
Call Your Doctor TOP
After arriving home, contact your doctor if any of the following occurs:
In case of an emergency, call for medical help right away.
American Academy of Family Physicians
American Congress of Obstetricians and Gynecologists
Canadian Women’s Health Network
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.
LEEP patient pamphlet. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/publications/patient_education/bp110.cfm . Accessed April 10, 2009.
Neff D. Endometrial ablation. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated May 2009. Accessed September 30, 2009.
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.
Patient fact sheet: LEEP. American Society for Colposcopy and Cervical Pathology website. Available at: http://www.asccp.org/pdfs/patient_edu/leep.pdf . Accessed April 10, 2009.
Last reviewed November 2012 by Andrea Chisholm, MD
Last Updated: 11/26/2012