Loop electrical excision procedure

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The loop electrosurgical excision procedure (LEEP) is one of the most commonly used approaches to treat high grade cervical dysplasia (CIN II/III, HGSIL) discovered on colposcopic examination. In the 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 IV sedation or 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. A survey study has indicated that the LEEP procedure does not appear to affect fertility.[4] On the other hand, a case-control study has found an association between surgical treatment of CIN lesions and risk of infertility or subfertility, with an odds ratio of approximately 2.[5] Scarring of the cervix is a theoretical mechanism of causing 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. A cohort study came to the result that women with a time interval from LEEP to pregnancy of less than 12 months compared with 12 months or more were at significantly increased risk for spontaneous abortion, with risk of miscarriage of 18% compared with 4.6%, respectively.[6] On the other hand, no increased risk was identified for preterm birth after LEEP.

References

  1. "Loop electrosurgical excision procedure (LEEP) for abnormal cervical cell changes". Retrieved 2007-12-28.
  2. Mayeaux, Jr., E.J. "Advantages of LEEP". Retrieved 2007-12-28.
  3. "LEEP Procedure — What is LEEP? — Loop Electrosurgical Excision Procedure". Cornforth. About.com. Tracee. Retrieved 2007-12-28. Check date values in: |date= (help)
  4. Turlington WT, Wright BD, Powell JL (November 1996). "Impact of the loop electrosurgical excision procedure on future fertility". J Reprod Med. 41 (11): 815–8. PMID 8951130.
  5. Spracklen, C. N.; Harland, K. K.; Stegmann, B. J.; Saftlas, A. F. (2013). "Cervical surgery for cervical intraepithelial neoplasia and prolonged time to conception of a live birth: A case-control study". BJOG: an International Journal of Obstetrics & Gynaecology. 120 (8): 960–965. doi:10.1111/1471-0528.12209. PMC 3691952. PMID 23489374.
  6. Conner SN, Cahill AG, Tuuli MG, Stamilio DM, Odibo AO, Roehl KA; et al. (2013). "Interval from loop electrosurgical excision procedure to pregnancy and pregnancy outcomes". Obstet Gynecol. 122 (6): 1154–9. doi:10.1097/01.AOG.0000435454.31850.79. PMC 3908542. PMID 24201682.

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