Loop electrical excision procedure

The loop electrosurgical excision procedure (LEEP) is currently one of the most commonly used approaches to treat high grade cervical dysplasia (CIN II/III, HGSIL) discovered on colposcopic examination. In UK it is known as "large loop excision of the transformation zone" (LLETZ).^[1] The procedure has many advantages including low cost, high success rate, and ease of use. The procedure can be done in an office setting and usually only requires a local anesthetic, though sometimes a general anesthetic is used.^[2]

Process

When performing a LEEP, the physician uses a wire loop through which an electric current is passed at variable power settings. Various shapes and sizes of loop can be used depending on the size and orientation of the lesion. The cervical transformation zone and lesion are excised to an adequate depth, which in most cases is at least 8 mm, and extending 4 to 5 mm beyond the lesion. A second pass with a more narrow loop can also be done to obtain an endocervical specimen for further histologic evaluation.^[3]

The LEEP technique results in some thermal artifact in all specimens obtained due to the use of electricity which simultaneously cuts and cauterizes the lesion, but this does not generally interfere with pathological interpretation.

Complications

Complications are less frequent in comparison to a cold knife conization, but can include infection and hemorrhage. Damage to the cervical stroma may lead to cervical stenosis or incompetence. The LEEP does not appear to affect fertility.^[4] Scarring of the cervix can, however, lead to trouble conceiving. This scar tissue can be massaged or broken up in a number of ways, thus allowing the cervical opening to dilate back to normal size. However, a study in 2007 indicated that LEEP appears to increase the risk of premature rupture of the membranes during subsequent pregnancies which may lead to preterm delivery.^[5]

See also

• Cervicectomy

References