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.

Getting Ready

The week before your procedure:

• Ask a family member or friend to drive you home after your procedure. Do not drive yourself home.
  
  
• Ask your caregiver how many days before the procedure you need to stop having sexual intercourse (sex).
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Dye may be used during your procedure to help caregivers mark abnormal tissues in your vagina and cervix. Tell your caregiver if you are allergic to any dye.
  
  
• Tell your caregiver if you have had a LEEP, Pap smear, colposcopy, or other similar procedures before and when they were done.
  
  
• Tell your caregiver if you have other known diseases. These diseases may include diabetes (high blood sugar level), bleeding disorders, or heart, liver, or kidney problems. Your caregiver may also need to know if you have had lower genital tract surgeries in the past.
  
  
• Tell your caregiver if you know or think you might be pregnant.
  
  
• You may need to have a pregnancy, urine, or blood test. Ask your caregiver for more information about these tests. Write down the date, time, and location of each test.

The day of your procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• Ask your caregiver before taking any medicine on the day of your procedure. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• Your caregiver may have you take a pain reliever before the procedure.
  
  
• An anesthesiologist may talk to you before your procedure. This caregiver may give you medicine to make you sleepy during your procedure.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the procedure. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

• You will need to change into a hospital gown. Caregivers may give you medicine to make you calm and comfortable during the procedure. You will be instructed to empty your bladder before the procedure. Feel free to ask for a woman to be present during your procedure. You will be 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 do an exam to check your vagina and cervix. Your vagina, cervix, and the area between your legs will be cleaned with soap and water. Sheets and clean towels will be put over your lower body to keep the procedure area clean.
  
  
• Your caregiver will gently put a warmed speculum (tool) in your vagina. This tool helps to widen and hold open your vagina so your caregiver may better see your cervix. He will also place a colposcope 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 tissue. Your cervix will be swabbed with acetic acid (vinegar) or iodine dye. Vinegar will make the abnormal tissues turn white, while iodine will help your caregiver better see the abnormal tissue.
  
  
• Your caregiver will inject the abnormal areas with numbing medicine. He will use a special forceps (grasping instrument) to hold the cervix steady during the procedure. A wire loop will be 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 will be sent to a lab for further tests. Your caregiver will also use the wire to seal a blood vessel if there is bleeding. He will then wash the area with iodine or a saline (salt water) solution and apply a paste-like medicine. This will help to prevent bleeding. You will then 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.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have chills, a cough, or feel weak and achy.
  
  
• You have questions or concerns about your procedure.

Seek Care Immediately if

• You have blood, pus, or a foul-smelling odor coming out of your vagina.
  
  
• You have sudden severe (bad) abdominal (stomach) or vaginal pain.