| 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:
infection
bleeding
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.
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