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 TOP
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
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
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:
What to Expect TOP
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:
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 TOP
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. The solution will show the abnormal area that needs to be removed. A thin wire will be inserted 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 abnormal tissue will be removed. You will need to stay still. 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? TOP
LEEP only takes a few minutes.
How Much Will It Hurt? TOP
You may feel cramping during LEEP. You should not feel any sharp pain.
Post-procedure Care TOP
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:
There are also steps you can take to reduce your chances of infection such as:
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:
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 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). American Congress of Obstetricians and Gynecologists website. Available at:
...(Click grey area to select URL)
Updated July 2014. Accessed October 7, 2015.
Loop electrosurgical excision procedure (LEEP). American Society for Colposcopy and Cervical Pathology website. Available at:
...(Click grey area to select URL)
Accessed October 7, 2015.
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.
Last reviewed September 2015 by Andrea Chisholm, MD
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