LLETZ Procedure for Severe Dyskaryosis
What is a LLETZ Procedure?
If on a cervical screening test (HPV/smear test) or colposcopy you have been diagnosed as having high grade precancerous cervical cells (moderate/severe dyskaryosis/CIN2/CIN3) which require treatment, you will typically be referred for a LLETZ procedure after further tests.
LLETZ (Large Loop Excision of The Transformation Zone) also referred to as loop diathermy, LEEP, loop excision, or loop biopsy, is the most common treatment option for those with high-grade precancerous cells of the cervix. The abnormal cells are removed using a heated wire loop and drastically reducing the likelihood of cervical cancer.
What do LLETZ Procedures involve?
LLETZ treatment is a straightforward outpatient procedure, typically only taking 10-15 minutes. After numbing the cervix with a local anaesthetic injection, a thin heated wire loop with a mild electric current (known as diathermy) is used to remove the abnormal cells, while also aiming to preserve as much of the healthy cervix as possible.
On occasion, the treatment to remove abnormal cervical cells can be carried out immediately after the colposcopy examination. Our consultants would carry out the LLETZ procedure if it is extremely clear that some of the cells in the cervix are abnormal and require imminent removal. In other instances, it will not be possible to carry out procedures on cervical pathology on the same day.
This may be because we need to wait for biopsy results in order to determine whether abnormal cells need to be removed with the thin wire loop method or not. Our consultants will guide you on the next steps during your consultation. Our health professionals will ensure that you are well informed during the whole process so there will be no surprises.
Is the LLETZ procedure painful?
No, LLETZ treatment will not hurt. Although LLETZ sounds scary, patients typically only feel slight discomfort during the procedure. As local anaesthetic is used, patients will not be able to feel the removal of the cells from the cervix via the heated wire. They may only notice slight discomfort as the fine needle is placed to numb the area. Similar to the cervical screening, patients will be able to feel the movement of the speculum.
After the procedure, patients may experience slight pain, similar to a normal period, but this will quickly subside and can be eased with regular painkillers. There are rarely ever any lasting physical effects from this procedure.
If you find vaginal examinations very uncomfortable (including colposcopy) then the procedure should be performed under general anaesthetic as a day case.
What happens after the LLETZ procedure?
As LLETZ is usually an outpatient procedure, patients can go home right away and can immediately resume normal activities. We advise that patients take the day off when having treatment but should be able to return to work the next day. Some discomfort is common after the procedure, but this can be alleviated with over-the-counter painkillers and a hot water bottle.
Vaginal discharge and blood spotting are normal for the first week after the procedure. For the next 4 weeks we advise patients to avoid the following activities:
- Wearing tampons. It is recommended that you use sanitary towels instead
- Having sex for four weeks, as this increases the risk of infection
- Heavy exercising, including swimming, for at least two weeks or while bleeding or discharge are still present. Light exercising, such as brisk walking, is fine.
The first period after treatment may arrive earlier or be slightly heavier than your normal period, but this should settle.
Six months after your LLETZ procedure, you will be asked to undergo another cervical screening. This will be carried out to check that there are no abnormal cells or infection with a high risk type of the Human Papilloma Virus (HPV).
Will abnormal cells be gone after the LLETZ procedure?
There is a strong chance that you will be “cured” following the LLETZ procedure to remove abnormal cells. However, a very small number of patients may need to undergo further treatment, and this will be determined six months after the LLETZ procedure, where you will be invited to undergo another cervical screening for potential cervical cancer cells.
In future, it is vital to continue undergoing your cervical screening as advised, because abnormal cells can be detected at any time.
Are There Risks Associated With LLETZ Procedures?
The potential risks associated with the LLETZ procedure are very low, but there are some side effects that you should be aware of. These include:
- Mild cervical or pelvic pain, which can be similar to period pain and typically passes within a few hours of treatment.
- Bleeding from the cervix, which may require further surgery
- An infection which may require treatment with antibiotics
- Slightly increased risk of premature birth in any future pregnancy
- If after the procedure you feel unwell, develop a foul-smelling discharge, or notice significant pain or bleeding that is much heavier than your normal period, you should contact your GP immediately, as this can indicate an infection.
Does LLETZ affect fertility or cause pregnancy problems?
No, it does not. The treatment aims to remove the abnormal cells from the cervix but preserve as much of the healthy cervix as possible to support future pregnancies. It is extremely unlikely that a woman who has had LLETZ treatment for abnormal cells will experience fertility issues.
However, after LLETZ treatment, there is a small increased risk of premature birth, before 37 weeks. This risk is dependent on the amount of cervical tissue that was removed during treatment or if you have had more than one LLETZ procedures.
If you are pregnant or are thinking of getting pregnant in the future, it is important to let your GP know that you have had treatment for abnormal cervical cells in order to be referred to a consultant’s antenatal clinic.
Are There Risks Associated With LLETZ?
The potential risks associated with a LLETZ procedure are very low but there are some side effects that you should be aware of. These include:
- Mild pain, which can be similar to period pain and typically passes within a few hours of treatment
- Bleeding from the cervix, which may require further surgery
- Infection which may require treatment through antibiotics
- Increased risk of premature birth in any future pregnancy, though this is highly uncommon