Loop electrical excision procedure: Difference between revisions

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The '''loop electrosurgical excision procedure''' ('''LEEP''') is currently one of the most commonly used approaches to treating high grade [[cervical dysplasia]] discovered on [[colposcopy|colposcopic]] examination. It is also known as "large loop excision of the transformation zone" (LLETZ).<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 |accessdate=2007-12-28}}</ref> The procedure has many advantages including low cost, high success rate, and ease of use. The procedure can be done in an office setting and usually only requires a local [[anesthesia|anesthetic]], though sometimes a general [[anesthesia|anesthetic]] is used.<ref>{{cite web |url=http://lib-sh.lsuhsc.edu/fammed/atlases/leep/leepadv.html |title= Advantages of LEEP|accessdate=2007-12-28 |last=Mayeaux, Jr. |first= E.J.|format= |work= }}</ref>

When performing a LEEP, the [[physician]] uses a wire loop through which an electrical current is passed at variable 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|accessdate=2007-12-28 |last= |first= |coauthors= |date=Tracee |work= Cornforth|publisher=About.com}}</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. Complications are less frequent in comparison to a [[cold knife conization]], but can include [[infection]] and [[hemorrhage]]. Damage to the cervical [[stroma]] may lead to cervical stenosis or [[cervical incompetence|incompetence]]. The LEEP does not appear to affect [[fertility]].<ref>{{cite web |url=http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&list_uids=8951130&cmd=Retrieve&indexed=google |title=Impact of the loop electrosurgical excision procedure on future fertility. |accessdate=2007-12-28 |last=Turlington |first=WT |coauthors= Wright BD, Powell JL|date=November , 1996 |work= |publisher=Department of Obstetrics and Gynecology, University of North Carolina, School of Medicine, Wilmington, USA.}}</ref> However, a recent study indicated that LEEP appears to increase the risk of premature rupture of the membranes during subsequent pregnancies which may lead to preterm delivery.<ref>{{cite web |url=http://women.webmd.com/news/20040504/cervix-treatment-may-endanger-pregnancy-later|title=Cervix Treatment May Endanger Pregnancy Later