Loop Electrosurgical Excision Procedure (Conization)

WHAT IS A LOOP ELECTRO EXCISION PROCEDURE?

The initials LEEP mean “Loop Electrosurgical Excision Procedure”. This is a diagnostic or therapeutic procedure if you have an abnormal Pap smear, and involves the visible portion of the cervix. A thin metal loop is attached to a high frequency electric generator, allowing accurate removal of the abnormal cervical tissue, while leaving the healthy tissue intact. The electric energy generated allows precise excision and blood coagulation to form part of the same procedure.

THE LEEP PROCEDURE

The procedure must be performed outside the menstrual period to gain a better view of the cervix. Ideally, it should take place just before your period. You can take pain-relief medication (e.g. paracetamol) beforehand. You will lie on an examination table as you would for a gynecological examination and the speculum will be inserted as it would be for a Pap smear. A local anesthetic (similar to that dentists use) is applied. You may feel some menstrual-type cramping during the cervical injection. Sometimes, patients feel an increase in heart rate or tremor in their legs. These symptoms are normal and related to the treatment. A colposcopy examination is repeated and the actual procedure can take place. You will hear the sound of the smoke evacuator tube and the electric generators, but you will feel nothing. It is VERY IMPORTANT to remain completely still at this point in order not to damage the walls of the vagina, which are not anesthetized. You may feel menstrual-type cramps during the procedure or afterwards. Removal of the tissue only takes a few seconds, then the cervix is cauterized to stop bleeding. A hemostatic solution (Monsel solution) is applied, and the speculum is withdrawn.

RISKS WITH LEEP

Risks and complications with LEEP are very rare. However, the following may occur:

• Heavy bleeding (heavier than during your period)
• Abdominal pain
• Fever
• Discharge with an unpleasant odour
• Incomplete removal of the abnormal tissue
• Partial closure of the cervix

ADVANTAGES OF LEEP

The main advantage of LEEP is that it is a relatively painless, non-invasive procedure, allowing only abnormal tissue to be removed using local anesthesia.

POSTOPERATIVE CARE

Postoperative follow-up after LEEP is very important. You should expect some bleeding after the procedure, as well as menstrual cramps and brownish discharge. Contact the clinic immediately if one of the following symptoms appears:

1. Persistent bleeding that is heavier than during your period, or the presence of clots
2. Severe abdominal pain
3. Temperature above 38.5° Celsius

If these symptoms occur when the clinic is closed or during the weekend, contact or go to a hospital emergency room.

During the 3 weeks after treatment, you should follow the recommendations given below:

1. Insert nothing into the vagina:

• No sexual relations
• No baths; only showers
• No ovules or other types of cream
• No tampons; only sanitary pads

2. No Aspirin or derivatives containing acetylsalicylic acid

3. No strenuous activities (horseback riding, cycling, ATV, etc.)

Bleeding may appear:

• Sometimes as much as with your period
• Sometimes black and foul-smelling

This bleeding may:

• Be slight at the beginning and increase after 10 days
• Last until your next period
• Be accompanied by menstrual-type pain.