LEEP Procedure - Indications, Preparations, Procedures, Advantages, and Complications

What Is a LEEP Procedure?

Loop electrosurgical excision procedure (LEEP) is used to remove or excise abnormal tissues from the surface of the cervix or the vagina. This procedure is usually used as a diagnostic tool or as a treatment modality in cases of cancer and some other conditions. The procedure is named after the tool used (a wire loop that is heated with the help of electric current and used for exciting tissues).

What Are the Indications of a LEEP Procedure?

Doctors prescribe a LEEP procedure after a pap smear, colposcopy biopsy, or routine pelvic examination. The LEEP procedure is helpful in the diagnosis and treatment of the following conditions-

• Cervical dysplasia.

• Genital warts and polyps.

• Abnormal cells might transform into cancerous cells.

• Abnormal precancerous or benign growths.

• Human papillomavirus (HPV).

LEEP procedure is contraindicated for women with pelvic inflammatory disease or acute cervix inflammation. In these cases, a cone biopsy (excision of a cone-shaped tissue sample) or cryotherapy (use of extreme cold to remove abnormal tissue) can be recommended.

How to Get Prepared for the LEEP Procedure?

• The LEEP procedure is scheduled a week after the period's end. This allows the doctor to visualize the cervix better and monitor any bleeding caused by the procedure.

• All medications must be stopped before the procedure after taking advice from the doctor.

• Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided as they can increase the risk of bleeding during the procedure.

• Avoid having sexual intercourse, douches, or vaginal creams 24 hours before the procedure.

• If pregnancy is suspected, it must be informed to the doctor.

• A sanitary pad must be kept handy for bleeding or discharge after the procedure.

How Is the LEEP Procedure Performed?

LEEP can be performed at a doctor's office and takes less than 30 minutes. The procedure and instruments are explained to the patient before commencing LEEP. The following steps are involved in the LEEP procedure-

• The patient is advised to wear the hospital gown and lie down on the operating table with her feet in stirrups.

• A grounding pad is kept on the patient's thighs to protect her from electrical shocks.

• The doctor will insert a speculum device into the vagina to spread the vaginal canal walls to get a better and clear view of the cervix. A colposcopy can also be used to magnify the tissues of the cervix.

• A vinegar-like solution is used to clean the cervix; this makes the abnormal cells white and thus easy to identify. Iodine can be used instead of vinegar. It stains the normal cervical cells in brown color, and therefore it becomes easy to distinguish between normal cells and abnormal cells.

• Before beginning LEEP, a local anesthetic is administered to numb the cervix.

• The doctor will pass the wire loop through the speculum and begin scraping away any abnormal tissues. Some pressure or slight cramping may be felt.

• In extreme pain or fainting, a higher dose of anesthetic can be administered.

• After successfully removing all the abnormal tissue, medication is applied to stop bleeding.

• The removed tissues can be sent to a lab for further testing.

• The patient is asked to rest for a few minutes before discharge.

How Is Recovery After the LEEP Procedure?

After the procedure, the nurse will explain to the patient how to care for herself at home. The following guidelines can be followed-

• The patient must take rest for one or two days after the procedure.

• Painkillers like Acetaminophen or Ibuprofen can be administered in case of discomfort. NSAIDs should be avoided.

• Nothing should be placed inside the vagina (tampons or douches).

• Avoid vaginal sexual intercourse for at least four weeks after the procedure.

• A brown discharge can be expected one to two days after the procedure.

• Vaginal bleeding (like menstrual flow) can occur for a few days after the procedure. However, more vaginal bleeding can be expected 10 to 12 days later during the healing period.

• Avoid strenuous activity for a week after the procedure.

• It is normal to have a late or heavy period after the procedure.

• Proper follow-up after the procedure.

What Are the Risks Associated with the LEEP Procedure?

Though the LEEP procedure is very safe and effective, there could still be some risks of–

• Infection.

• Bleeding during or after the procedure.

• Scarring on the cervix.

• Emotional changes in the women.

• Sexual dysfunction.

• One must seek immediate medical attention and help in case of–

  • Fever and chills.

  • Blood clots or heavy vaginal bleeding.

  • Smelly vaginal discharge.

  • Severe belly pain.

  • Any unexplained or unexpected symptoms.

What Are the Advantages of a LEEP Procedure?

A LEEP procedure is a safe and effective way to prevent cervical cancer. It has a high success rate and high accuracy.

What Are Treatment Options for Cervical Dysplasia Other Than LEEP Procedure?

The choice of treatment depends upon the amount and location of abnormal tissues. Following methods other than the LEEP procedure can be used to remove the abnormal cells-

• Cryosurgery- The surface tissue is destroyed by freezing. Cryosurgery does not allow to review of the tissue to look for cancer in a pathology lab.

• Cold Knife Conization- A cone-shaped wedge of tissue is removed from the cervix. The excised tissue can be sent to a pathological lab to test for cancer.

• Laser Treatment or Cone Excision- High-intensity beam of light is used to produce heat and destroy abnormal tissue. This procedure does not leave a tissue sample for a pathology lab to inspect for cancer cells.

Conclusion

LEEP, also known as the 'see-and-treat' approach, is a safe and accurate method of diagnosing precancerous, benign, and cancerous conditions. It also helps to remove abnormal cells with minimal invasion. Though there could be some risks associated with the procedure, it is rare and usually safe. In addition, a LEEP can help confirm whether the abnormal pap results are related to cancer. Finally, if cell changes are cancerous, a LEEP procedure can aid in both diagnosis and treatment by removing those abnormal tissues.