Loop Electrosurgical Excision Procedure (LEEP)

By Nancy Bowers

(Large Loop Excision of the Transformation Zone [LLETZ], Large Loop Excision of the Cervix [LLEC], Loop Cone Biopsy of the Cervix)

Procedure overview

What is a loop electrosurgical excision procedure (LEEP)?

Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by electric current to remove cells and tissue as part of the diagnosis and treatment for abnormal or cancerous conditions in a woman’s lower genital tract.

The lower genital tract includes the cervix and vagina. The cervix is the lower, narrow part of the uterus (womb) and the vagina connects the cervix and the vulva (the external genitalia).

With LEEP, an electric current passes through the fine wire loop to cut away a thin layer of abnormal tissue. This tissue will be sent to the lab for examination. LEEP can also remove abnormal cells to allow healthy tissue to grow.

Other related procedures that may be used to diagnose cervical and vaginal conditions include Pap test, cervical biopsy, and colposcopy. Please see these procedures for additional information.

What are female pelvic organs?

The organs and structures of the female pelvis are:

  • Endometrium—the lining of the uterus

  • Uterus—also called the womb, the uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.

  • Ovaries—two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored and where the female sex hormones estrogen and progesterone are produced

  • Cervix—the lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body

  • Vagina—the passageway through which fluid passes out of the body during menstrual periods. Also called the "birth canal," the vagina connects the cervix and the vulva (the external genitalia).

  • Vulva—the external portion of the female genital organs

Reasons for the procedure

LEEP may be performed when cervical or vaginal problems are found during a pelvic examination, or abnormal cells are found during a Pap test. LEEP is also performed to detect cancer of the cervix or vagina.

Cells that appear to be abnormal, but are not cancerous at the present time, may be identified as precancerous. The appearance of these abnormal cells may be the first evidence of cancer that could develop years later.

LEEP may also be used to assist in the diagnosis or treatment of the following conditions:

  • Polyps (benign growths)

  • Genital warts, which may indicate infection with human papilloma virus (HPV), a risk factor for developing cervical cancer

  • Diethylstilbestrol (DES) exposure in women whose mothers took DES during pregnancy, as DES exposure increases the risk for cancer of the reproductive system

There may be other reasons for your physician to recommend LEEP.

Risks of the procedure

As with any surgical procedure, complications may occur. Some possible complications may include, but are not limited to, the following:

  • Infection

  • Bleeding

  • Changes or scarring in the cervix from removal of tissue

  • Difficulty getting pregnant

  • Potential for preterm birth or having a low birth weight baby

Patients who are allergic to or sensitive to medications, iodine, or latex should notify their physician.

If you are pregnant or suspect that you may be pregnant, you should notify your physician.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Certain factors or conditions may interfere with LEEP. These factors include, but are not limited to the following:

  • Menstruation

  • Acute pelvic inflammatory disease

  • Acute inflammation of the cervix

Before the procedure

  • Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

  • Generally, no prior preparation, such as fasting or sedation, is required.

  • If you are pregnant or suspect that you are pregnant, you should notify your physician.

  • Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, iodine, and anesthetic agents (local and general).

  • Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

  • Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

  • Your physician will give you instructions as to using tampons, vaginal creams or medications, douching, or having sexual relations before the procedure.

  • LEEP is usually performed when you are not having your menstrual period.

  • Your physician may recommend that you take a pain reliever 30 minutes before the procedure.

  • You may want to bring a sanitary napkin to wear home after the procedure.

  • Based upon your medical condition, your physician may request other specific preparation.