Loop Electrosurgical Excision Procedure

WHAT YOU SHOULD KNOW:

• Loop electrosurgical excision procedure (LEEP) is a procedure to check and treat conditions in a woman's lower genital tract. The lower genital tract includes the cervix (lower part of the womb) and vagina. The vagina connects the cervix and the vulva (the outside of the vagina). LEEP uses a wire loop that is heated by an electric current to remove abnormal tissue in the cervix and vagina. The abnormal tissue may include infections, warts, tumors, and polyps. LEEP is frequently used to diagnose and treat cervical intraepithelial neoplasia or CIN. CIN often develops into cancer and occurs when abnormal cells grow in the lining of the cervix.
  
  
• During LEEP, your caregiver may use dye to mark the abnormal tissue. This is done so the abnormal tissue is easier to remove. A low-voltage electric current passes through a fine wire loop that is attached to an electrical machine. A thin layer of abnormal tissue is cut and sent to the lab for tests. LEEP usually takes less than 10 minutes and is done when you are not having your monthly period. With LEEP, caregivers may correctly diagnose and treat your health problem and prevent further serious problems, such as cancer.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• LEEP is usually a common and safe procedure, though problems may happen during your procedure. Your body may react to the dye or medicines and cause nausea (upset stomach), skin itching, hives, or breathing problems. Tell your caregiver right away if you have any of these symptoms after getting the dye. Your vagina or cervix may get punctured or perforated (torn) due to increased pressure from the loop wire. It may also cause a burn on your vagina or cervix. You could have an infection or too much bleeding after the procedure. Following your caregiver's advice during and after the procedure may decrease your chances of having any problems.
  
  
• Without a LEEP procedure, you may not know what is causing your medical condition. The symptoms you presently have may become worse. Other serious medical problems, such as cancer, may not be diagnosed and treated correctly. Ask your caregiver if you are worried or have questions about your procedure, medicine, or care.

WHILE YOU ARE HERE:

Before your procedure:

• Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Gown: A hospital gown is used so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. When you feel better you may be able to wear your own gown or pajamas.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Anesthesia:
  
  
  • General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
    
    
  • Local anesthesia: Medicine is used to numb the area of your body where the surgery or procedure will be done. It is usually injected into the skin. It also may be given as a gel or jelly applied to your gums for dental procedures or as a patch. For such areas as the genitals, medicine may be given as a cream on the skin or mucus membranes.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

During your procedure:

• You will be instructed to empty your bladder. Caregivers may give you medicine to make you calm and comfortable during the procedure. You are asked to lie on a special table or bed and your legs will be put up in stirrups (leg holders). With gloved hands, your caregiver will check your vagina and cervix. Your vagina, cervix, and the area between your legs is cleaned with soap and water. Sheets and clean towels are put over you to keep the procedure area clean.
  
  
• Your caregiver gently puts a warmed speculum (tool) in your vagina. This tool helps to widen and hold open your vagina so your caregiver can better see your cervix. A colposcope will be placed at the opening of your vagina. A colposcope is an instrument with a special lens that helps your caregiver clearly see your vagina and cervix. He will look through the colposcope to check for any abnormal tissues. Acetic acid (vinegar) or iodine dye is applied to your vagina and cervix . Vinegar makes the abnormal tissues turn white, while iodine helps your caregiver better see the abnormal tissue. Pictures may be taken with the colposcope, or sketches of the abnormal areas on your cervix will be made.
  
  
• Your caregiver injects the abnormal areas with numbing medicine. He uses a special forceps (grasping instrument) to hold the cervix steady during the procedure. You may feel some cramping when the forceps are used. A wire loop is inserted through the vagina and passed through the abnormal tissues. More passes of the wire loop may be needed, depending on the amount and location of tissue to be removed. The tissue samples are sent to a lab for further tests. Your caregiver then washes the area with iodine or a saline (saltwater) solution and applies a paste-like medicine. This helps to stop any bleeding. You will be given a sanitary pad to wear over your vaginal area.

After your procedure:

You may lie in bed and rest for a while since the procedure may be a little tiring. Caregivers will watch you closely for any problems. Do not get out of bed or stand up until your caregiver says it is OK. When your caregiver sees that you are OK, you will be allowed to change clothes and go home. If your caregiver wants you to stay in the hospital, you will be taken back to your hospital room. It is normal to have some mild cramping, spotting, and dark or black-colored discharge for several days. The dark discharge is from the medicines or solutions that were applied to your cervix to control bleeding. Ask your caregiver for more information about vaginal care, such as when to change your sanitary pads.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Drinking liquids: Men 19 years old and older should drink about three Liters of liquid each day (about 13 eight-ounce cups). Women 19 years old and older should drink about two Liters of liquid each day (about 9 eight-ounce cups). Follow your caregiver's advice if you must change the amount of liquid you drink. For most people, healthy liquids to drink are water, juices, and milk. If you are used to drinking liquids that contain caffeine, such as coffee, these can also be counted in your daily liquid amount. Try to drink enough liquid each day, and not just when you feel thirsty.
  
  
• Medicines: You may need any of the following:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Monitoring: Caregivers may check for a pulse in your arms or wrists. This helps caregivers learn if you have problems with blood flow after your procedure. You may also have any of the following:
  
  
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.