Stephen R. Wells MD

WHY LEEP IS RECOMMENDED

This office-based procedure is routinely performed for the treatment of specific types of abnormal PAP smears. Some forms of abnormalities discovered by cervical biopsy may be treated by freezing the cervix with a metal probe, called “cryosurgery”. However, if the abnormalities found reveal moderate or severe precancerous changes, the abnormal cells must be removed. The LEEP procedure accomplishes this with minimal discomfort in an office setting.

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The following is a brief description of the procedure and is designed to answer any questions you may have. It is my desire for you to understand why there is a need for the LEEP, and to make you feel more comfortable with the procedure.

 

HOW LEEP IS PERFORMED

If LEEP is being performed, you have already had the colposcopic examination for diagnosis following an abnormal Pap smear. The first part of the LEEP procedure involves performing a repeat colposcopic examination. Once the areas of concern are identified again, the LEEP is performed. The speculum used is shielded and do not conduct / transmit electricity. A vacuum tube is placed within this specialized speculum to evaculate smoke produced during the procedure (Keep in mind we’re talking about a very small amount of smoke produced from the cautery device, but it’s enough to obscure our visualization of the cervix). The cervix is then painted with an Iodine containing paint. This outlines the abnormal cells very well, as normal cells which contain glycogen absorb the stain in large amounts, turning a deep brown color. Since the abnormal cells do not contain large amounts of glycogen, they maintain a normal fleshy color and are thus highlighted. At this time, Lidocaine with epinephrine anesthetic is injected into the cervix. I will let you know when I am injecting this medication. About 30 seconds after I inject the medicine, you will notice that your heart rate increases dramatically and you may feel a little shaky. This sensation will last approximately 60 seconds then will regress. Once the cervix is numb, a loop electrode will pass through the cervix (like a knife cutting through softened butter) removing the abnormal tissue. It may be completed with a single pass or with several passes, depending upon the shape of the cervix and the size of the lesion to be removed. Once all of the abnormal tissue is removed, a ball-shaped electrode is used to cauterize the area from which the abnormal cells were removed. This effectively stops any bleeding caused by the procedure. Finally, a chemical cautery paste is placed on the cervix to prevent any further bleeding. Once this is done, the speculum is removed and the procedure complete.

 

BENEFITS, RISKS AND ALTERNATIVES

There are two benefits to the LEEP procedure: First, the procedure confirms that the cervical lesion has not progressed beyond what was expected based on the results of the previously performed colposcopy and biopsy. Second and most importantly, the LEEP removes the abnormal cells that ultimately could have led to cancer. The main risks of the procedure include those common to other surgical procedures: Bleeding and Infection. These risks are extremely rare. Heavy bleeding, if it occurs, can be stopped by using electrocautery or sutures. Infection can be treated by using antibiotics.

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The only other risk to be mentioned is that which can complicate a future pregnancy. Since we are removing some of the cervix when performing the procedure, the cervix can become weakened. A weakened cervix can dilate during the early part of a pregnancy, leading to miscarriage. It should be stressed that this complication is extremely rare. It is mentioned only to be thorough in the explanation of risks involved. There is however treatment for a weakened cervix during pregnancy, called “incompetent cervix”. A stitch can be placed in the cervix to keep it from dilating prematurely. The stitch is left in place until one month prior to a woman’s due date, at which time it is removed. The stitch, called a cerclage, is very effective in allowing the pregnancy to continue until term.

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Regarding the condition of incompetent cervix, the benefit of the LEEP procedure in preventing the progression of dysplasia clearly outweighs the risks of weakening the cervix. The alternative to LEEP procedure includes following the lesion over time to see if it will regress and disappear over time. Rarely will these lesions spontaneously go away, although it does happen. If this approach is desired, then it is imperative to perform Pap smears and colposcopy at frequent intervals. Most physicians would not encourage a patient with moderate to severe dysplasia to “wait and see”.

 

AFTER CARE

Following the LEEP procedure, there should be minimal discomfort. Some mild cramping may be expected and relieved with Advil or other mild over-the-counter pain relievers. A discharge consisting of old blood and dried chemical cautery agent may be expected for up to several weeks following the LEEP procedure. There should be no other unusual side effects. We will ask you to come back to the office two weeks following the procedure to check the cervix to make sure it is healing appropriately.