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The '''loop electrosurgical excision procedure''' ('''LEEP''') is one of the most commonly used approaches to treat high grade [[cervical dysplasia]] (CIN II/III, HGSIL) discovered on [[colposcopy|colposcopic]] examination. In the UK, it is known as '''large loop excision of the transformation zone''' ('''LLETZ'''). It is considered a type of [[Cervical conization|conization.]]
LEEP has many advantages including low cost and a high success rate.<ref>{{cite web |url=http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-procedure-leep-for-abnormal-cervical-cell-changes |title=Loop electrosurgical excision procedure (LEEP) for abnormal cervical cell changes |access-date=2016-11-27}}</ref> The procedure can be done in an office setting and usually only requires a [[local anesthetic]], though sometimes IV sedation or a [[general anesthetic]] is used.<ref>{{cite web |url=http://lib-sh.lsuhsc.edu/fammed/atlases/leep/leepadv.html |title=Advantages of LEEP |access-date=2007-12-28 |last=Mayeaux |first=E.J. Jr.|url-status=dead |archive-url=https://web.archive.org/web/20060904092302/http://lib-sh.lsuhsc.edu/fammed/atlases/leep/leepadv.html |archive-date=2006-09-04 }}</ref> Disadvantages include reports of decreased sexual satisfaction <ref name=":0" /> and potential for [[preterm labor]], though a meta-analysis suggested that in patients with existing CIN lesions as opposed to controls, the risk is not more than their baseline risk.
==Process==
When performing a LEEP, the [[physician]] uses a wire loop through which an [[electric current]] is passed at variable [[Power (physics)|power]] settings. Various shapes and sizes of loop can be used depending on the size and orientation of the lesion. The [[cervix|cervical]] transformation zone and [[lesion]] are excised to an adequate depth, which in most cases is at least 8 mm, and extending 4 to 5 mm beyond the lesion. A second pass with a more narrow loop can also be done to obtain an [[endocervical]] specimen for further [[histology|histologic]] evaluation.<ref>{{cite web |url=http://womenshealth.about.com/cs/surgery/a/leepprocedure.htm|title= LEEP Procedure — What is LEEP? — Loop Electrosurgical Excision Procedure|access-date=2007-12-28 |first=Tracee |last= Cornforth|publisher=About.com|archive-url=https://web.archive.org/web/20070502071454/http://womenshealth.about.com/cs/surgery/a/leepprocedure.htm|archive-date=2007-05-02}}</ref>
The LEEP technique results in some thermal artifact in all specimens obtained due to the use of electricity which simultaneously cuts and cauterizes the lesion, but this does not generally interfere with [[pathology|pathological]] interpretation provided depth is not exceeded.<ref>{{Cite journal |last1=Khunamornpong |first1=S. |last2=Raungrongmorakot |first2=K. |last3=Siriaunkgul |first3=S. |date=April 2001 |title=Loop electrosurgical excision procedure (LEEP) at Maharaj Nakorn Chiang Mai Hospital: problems in pathologic evaluation |url=https://pubmed.ncbi.nlm.nih.gov/11460961/ |journal=Journal of the Medical Association of Thailand = Chotmaihet Thangphaet |volume=84 |issue=4 |pages=507–514 |issn=0125-2208 |pmid=11460961}}</ref> The thermal artifact can be a function of depth and time.
==Complications==
Complications are less frequent in comparison to a [[cervical conization|cold-knife conization]] but can include [[infection]] and [[hemorrhage]].
A survey study has indicated that the LEEP procedure does not appear to affect [[fertility]].<ref>{{cite journal |vauthors=Turlington WT, Wright BD, Powell JL |title=Impact of the loop electrosurgical excision procedure on future fertility |journal=J Reprod Med |volume=41 |issue=11 |pages=815–8 |date=November 1996 |pmid=8951130 }}</ref> On the other hand, a [[case-control study]] has found an association between surgical treatment of CIN lesions and risk of [[female infertility|infertility]] or subfertility, with an odds ratio of approximately 2.<ref>{{Cite journal | last1 = Spracklen | first1 = C. N. | last2 = Harland | first2 = K. K. | last3 = Stegmann | first3 = B. J. | last4 = Saftlas | first4 = A. F. | title = Cervical surgery for cervical intraepithelial neoplasia and prolonged time to conception of a live birth: A case-control study | doi = 10.1111/1471-0528.12209 | journal = BJOG: An International Journal of Obstetrics & Gynaecology | volume = 120 | issue = 8 | pages = 960–965 | year = 2013 | pmid = 23489374 | pmc =3691952 }}</ref> Scarring of the cervix is a theoretical mechanism of causing trouble conceiving. This scar tissue can be massaged or broken up in a number of ways, thus allowing the cervical opening to dilate back to normal size.
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