LLETZ procedure

What is a LLETZ procedure?

LLETZ stands for Large Loop Excision of the Transformation Zone, which is a simple, fast procedure to remove pre-cancerous cells from the cervix. It’s also called a Loop Electrosurgical Excision Procedure or LEEP.

The loop is a thin hot wire that’s used to remove the abnormal cells from the surface of the cervix after you’ve received a local or general anaesthetic. The transformation zone is the area on the cervix where the precancerous change usually starts.

Why do I need a LLETZ procedure?

It’s common for minor or low grade abnormal cells to develop on the cervix and they often disappear by themselves. However, sometimes a colposcopy indicates the presence of high grade abnormal cells and simple treatment is necessary to remove them.

It’s important to remember that these cells are not cancer, but pre-cancerous with the potential of developing into cancer if left untreated.

As a specialist gynaecologist, I advise women to have a LLETZ or LEEP procedure after they’ve received an abnormal Pap smear result and a colposcopy confirms the presence of high grade abnormality or precancerous cells on the cervix.

How soon should I have a LLETZ procedure?

Usually, I recommend having the LLETZ procedure as soon as possible because I’m unable to predict how long it’ll take for the cancerous change to start in any given individual. I strongly recommend to have the procedure within 2-6 weeks, depending on the timing of your last period.

Do you perform this procedure in your Rooms?

Yes, I’m one of the few gynaecologists who offers this procedure under a local anaesthetic in our Rooms, which means only the cervix will be numbed and you’ll be awake. However, having the procedure while awake isn’t recommended for everyone. The other option is to have the procedure under a general anaesthetic in an operating theatre.

We’ll discuss the different options during your consultation, so you can ask me any questions regarding the procedure.

Are there any risks with a LLETZ procedure?

While LLETZ is generally a safe procedure, no operation is completely without risk. However, since LLETZ is recommended to prevent women from developing cancer, the benefits outweigh the risks.

The main risks associated with LLETZ are bleeding, infection and scarring.

Bleeding

Bleeding can occur at the time of the procedure though this is uncommon. It’s more common, up to 5%, to experience bleeding in the second week after the procedure.

Bleeding in the second week from the procedure usually resolves with rest and antibiotics. Uncommonly, this may require hospital admission and a return to the operating theatre to control the bleeding.

Infection

1 in 20 women may experience infection at the site of surgery and bleeding 7-10 days after surgery. This usually responds to routine antibiotics.

Scarring

Rarely, the procedure can cause scarring of the cervix called stenosis.

Follow-up

There’s a less than 5% chance of having abnormal cells remaining at the edges of the tissue that was removed. This may only require follow-up colposcopy observation. Occasionally, I have to recommend a repeat procedure. 

Scarring of the cervix, called stenosis, is rarely a cause of having difficulty falling pregnant.
Any woman planning a pregnancy has a small risk of premature birth, when the child is born before 37 weeks. The LLETZ procedure adds a minimal risk to the risk of premature birth. The risk of precancerous cells developing into cancer is comparatively many times higher.
The tissue removed during a LLETZ procedure is sent to a pathologist. In most cases, the results will be available in 2-3 days. I realise this is an anxious time for you, so I’ll ring you as soon as I have your results.

A LLETZ procedure is a day surgery procedure, which means you go home the same day. We do recommend you take time off from work for the rest of the day to recover from the anaesthetic. Some women may require an additional day’s rest after an anaesthetic. 

Contraception
You’re advised to take appropriate precautions or use effective contraception after your last period ahead of the procedure to avoid the risk of falling pregnant before the procedure or during the cycle that the procedure has been scheduled. Condoms are generally not considered to be effective contraception by themselves.

If you’re taking the combined oral contraceptive pill, we recommend you ‘skip’ the next period by omitting the sugar tablets and continuing with the pill without taking a break.

Want to make an appointment?