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	LEEP/LLETZ

LEEP (Loop Electrosurgical Excision Procedure) and LLETZ (Large Loop Excision of the Transformation Zone) are surgical procedures used for the management of abnormal pap smears.  The abnormal tissue is removed by an electrified wire using radio frequency cutting current.  The wire cuts as well as cauterizes (stops the bleeding).  The risks are small and the treatment results are excellent.

 

Since the procedure is easily accomplished and of minimal discomfort it is safely performed in the office setting.  Ibuprofen or a similar medication to relax the uterus may be given prior to the procedure.  Lidocaine, a Novocaine type anesthetic, is administered locally prior to the procedure, along with epinephrine to prevent bleeding.  The epinephrine may give you a flushed feeling and a slightly faster heartbeat.  Monsel's Solution (ferrous subsulfate) paste may be used to control the bleeding.

 

Patients can expect mild bleeding for 1-3 days.  The maximum discharge is in the first hours, tapering to light pink during the 2-4 weeks after the procedure.  Rarely does bleeding require suturing.

 

Abstain from intercourse, tampons and douching for 2 weeks unless otherwise instructed.  Healing is complete by 2-4 weeks depending on the depth.  During the procedure, a grounding pad is attached to the patient.  The specimen excised is sent to pathology for examination.

Prior to LEEP:

1. Arrive 15 minutes prior to your appointment time. You will be given medication to relax the uterus during the procedure. Feel free to bring your favorite music/MP3 player.
2. You cannot have your period.
3. Someone can come with you to drive you home, if you need company, but you may drive yourself.  

During LEEP: 

1. The speculum is in the vagina throughout the procedure.
2. Lidocaine will be injected into the cervix for anesthesia.
3. During the procedure it is important that you do not move. If you become uncomfortable, please tell the nurse. The doctor will be asked to stop so you can reposition.

After LEEP: 

1. You may have a discharge lasting the full 4 weeks. It may be thick or watery. It will most likely have an odor. Sanitary pads should be changed frequently. Showers and/or tub baths can be taken. The discharge may be clear, tan, milky, pink, or light red. IF discharge is heavy and red like a period, call the office.
2. Do not use tampons or have intercourse for 2 weeks unless otherwise instructed.
3. You will be notified of final results in 7-14 days when they are ready. The procedure is 95% curative.
4. You will have a follow-up appointment at 3 and 6 months.
5. Colposcopy and pap may be repeated at 3 and 6 months.

Remember - a yearly pap smear can help prevent cervical cancer!

DO NOT TAKE ANY ASPIRIN (ACETYLSALICYLIC ACID, ASA) FOR 48 HOURS BEFORE OR FOR 4 WEEKS AFTER LEEP (USE TYLENOL OR ADVIL).