LEEP - Gynaecological and Ultrasound Private Surgery Debrecen, Hungary dr János Zatik

  gynaecologist dr János Zatik 48 Szent Anna u. Debrecen, Hungary    


János Zatik, M.D., Ph.D.
Assistant professor


Szent Anna Women's OB/GYN and Ultrasound Outpatient Clinic
48 Szent Anna utca
Debrecen, Hungary


4 p.m. to 8 p.m. on Tuesday, Thursday and Friday
by appointments



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Flying during pregnancy

Dilatations and Curettage (D&C) and quick form of endometrium biopsy with local anestesia

The LEEP Procedure



The LEEP Procedure

LEEP - Loop Electrical Excision Procedure
LLETZ - Large Loop Excision of the Transformation

Loop electrosurgical excision procedure (LEEP) is an electronic wire loop to remove praecancerosus tissue from the cervix vagina and vulva, a laser like procedure if you use pulstile frekvency generator. It is a diagnostic and also a therapeutic procedure at the same time. We remove the abnormal or cancerous lesions from the woman's lower genital tract. The lower genital tract includes the cervix and vagina and vulva. The cervix is the lower, narrow part of the uterus (womb) and the vagina connects the cervix. The vulva is the name of the external genitalia. With LEEP, an electric current passes through the fine wire loop to cut away a thin layer (2-6 mm) of abnormal tissue. This tissue will be sent to the hystology-lab for examination. LEEP can also remove abnormal cells to allow healthy tissue to grow. Vaginaly and also possible to perform cervix biopsy, or to remove verruca, or any other lesions on the cervix and vulva.

The organs and structures of the female pelvis are:

endometrium - the internal lining of the uterus, every months causing the menstruacion

uterus (womb) - is a hollow, pear-shaped muscle organ located in a woman's lower abdomen, between the bladder and the rectum, we can perform operation the uterus transvaginally..

ovaries - two female reproductive organs located in the pelvis in which egg cells (ova or ovum) develop and are stored and where the female sex hormones estrogen and progesterone are produced

cervix - the lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body.The cervical cancer one of the most common malignant diseases at younger age women, is screenable with cytology papanicolau test (PAP test) and colposcopy. If it is necessary before the cancer you can perform a LEEP to avoid devloping the cancer.

vagina - the passageway through which fluid passes out of the body during menstrual periods. Also called the "birth canal", the vagina connects the cervix and the vulva (the external genitalia).

vulva - the external part of the female genital organs (labia minora, maiora and hymen).

Reasons for the Procedure

LEEP may be performed when cervical or vaginal problems are found during a pelvic examination, or abnormal cells are found during a Pap test PIII! PIV-V. or HGSIL. LEEP is also performed to detect precancer or cancer of the cervix or vagina.

LEEP may also be used to assist in the diagnosis or treatment of the following conditions:

polyps (benign tumors)

genital warts, growths,condylomas,verrucas, which may indicate infection with human papilloma virus (HPV), a risk factor for developing cervical cancer

plastic surgical operation ont he vagina, vulva, hymen

There may be other reasons for your physician to recommend LEEP.

Are there risks of the procedure?

As with any surgical procedure, complications may occur. At LEEP it is very rare. Some possible complications may include, but are not limited to, the following:



changes or scarring in the cervix from removal of tissue

Allergic reactions-patients who are allergic to or sensitive to medications, iodine, or latex should notify their physician.

At pregnancy we can perform LEEP but say if you are pregnant

Certain factors or conditions may cous troubles and interfere with LEEP for example:menstruation ,PID pelvic inflammatory and cervical disease


Before the Procedure

Your doctor explain the LEEP to you and offer you the opportunity to ask any questions that you might have about the LEEP.

You will be asked to sign a consent form that gives your permission to do the LEEP. Read the text carefully and ask questions.

Do not eat and drink 2-3 hours befor LEEP but there are no special preparation, necessary for example fasting or sedation.

Notify if you are allergic pregnant or sensitiv to drugs,iodine,lidocaine, ibuprofen,or latex

Notify your doctor if you have a history of bleeding disorders or if you are using any anticoagulant (blood-thinning) medications, aspirin, clexane,syncumar,colfarit or any drugs that affect blood clotting. It may be necessary for you to stop these medications 5 days prior LEEP.

It is better not to use tampons, vaginal creams or medications, douching, or having vaginal sex before LEEP.

The procedure is better performed when you do not have menstruation.

You use a painkiller 25 minutes before the LEEP-Ibuprofen Advil ultra.

Your gynaecologist may request other specific treatment or preparation.

During the Procedure

LEEP isperformed in a gynaecologist's office, LEEP may vary depending on your condition and your physician's practices. But the steps are the followings:

1. Undress completely or from the waist down and put on a hospital gown.

2. Do not eat and drink a lot 2 hours before LEEP and empty your bladder prior to the operation

3. Lie on an examination table, with your feet and legs supported as for a gynaecological pelvic examination.

4. Gynaecologist insert a special speculum into the vagina to spread the walls of the vagina.

5. There is a colposcopic examination (Kolposcope, colposcope is an instrument with lens just like a microscope, to magnify the surfaces..

6. The gynaecologist will look through the colposcope to locate the lesion on the vulva, cervix or in the vagina.

7. Th cervix may be touched acetic acid and lugol-iodine solution. This helps make the abnormal tissues become more visible. You may feel a mild burning sensation. (Schiller test) We have to remove the white iodinenegative tissues.

8. The gynaecologist will inject Lidocain into the cervix at 3-6-9-12 O'clock part of the cervix using a small needle..

9. A forceps, and a aspeculum is used to hold the cervix steady for the procedure. You may feel some cramping when the tenaculum is used.

10. You will hear humming and/or blowing sounds from the equipment.

11. The loop will be inserted through the speculum and passed through the abnormal tissues. You may feel pressure or a slight cramping.

12. Important that you lie still and do not move a lot during the operation.

13. LOOP wires come in different sizes and shapes. Your gynaecologist will use which is the best for that situation, and lesion on your cervix.

14. The electrical current will act as a cautery to seal the blood vessels, so usually there is very little bleeding. Any bleeding from the LEEP site may be treated with a paste-like topical medication (for example Ironhydrochloride or Ironsulphat).

15. The tissue will be sent to a pathology-hystology-lab for histological examination.

After the LEEP

After the procedure, you can have rest for a few minutes(15-30 minutes) than you can go home.
You have to use pantyliner slips (hygenic pad)for bleeding., but must not use intravaginal tampon It is no problem to have some mild cramping, spotting, and dark or black-colored discharge for 5-8 days. If the amount of the discharge is not too much and you have no fever.
You must not not have intravaginal douche, use tampons, or have vaginal intercourse for about four weeks after LEEP.
You may also have other restrictions on your activity, for example no strenuous activity or heavy lifting.
You can take a painkiller for cramping or soreness , for exaexample ibuprofen or panadol but do not forget: the Aspirin or certain other pain medications may increase the chance of bleeding, so it is betterf not to take aspirin.
Generally we can mention: patients who have had LEEP will need more frequent Papanicolau tests the next years. After 2 weks the hystological result is aviable and you have to have a consultation, Latest 4-6 weeks ater the operation it is necessary to have a control examination.

Call your gynaecologist, or let you see on a visit if you have any of the following:

Havy bleeding with clots

Bad small discharge from your vagina

fever and/or chills

severe abdominal pain


Your gynaecologist may give you additional or alternate instructions after the operation, depending on your particular situation.


Szent Anna Women's OB/GYN and Ultrasound Outpatient Clinic - 48 Szent Anna utca
Debrecen, Hungary
János Zatik, M.D., Ph.D. assistant professor - www.zatik-nogyogyasz.hu