Loop Excision of Cervix
A loop excision of the cervix (also termed LLETZ) is an operation to remove pre-cancerous cells from the cervix (neck of the womb). It is required when women have high grade changes on their cervical smear. Treatment prevents these changes progressing to a cancer over time. It can also be offered to women that have persistent low grade abnormalities (mild changes that do not resolve with time).
A loop excision of the cervix is usually performed as an out-patient procedure with local anaesthesia but sometimes it is necessary to do it in theatre under general anaesthetic.
First, your doctor will perform a colposcopy examination (see Colposcopy and cervical biopsy patient information above). Once the abnormal cells have been identified, local anaesthesia is injected into the cervix to make the area numb. A thin wire loop with an electric current is then used to excise an area of cervix about the size of a fingertip. The tissue removed is sent to the laboratory for assessment. Most of the bleeding will be stopped during the operation but it is normal to have some light bleeding or discharge for up to four weeks. You should avoid sexual intercourse and using tampons for four weeks following treatment.
After an outpatient treatment you may have some mild 'period-like' discomfort which you can take paracetamol or ibuprofen for. You should be able to return to normal activity immediately but avoid strenuous exercise for at least two weeks.
The histology report from the laboratory is usually available within two weeks and your doctor will contact you with the results.
Risks of the procedure include bleeding and infection. If you experience very heavy bleeding you should seek urgent medical advice. If you develop any offensive discharge you should contact your doctor as you may need antibiotics
There is evidence to suggest that having two or more loop excisions of the cervix is associated with an increased risk of late miscarriage or pre-term labour in future pregnancies. The risk directly correlates to the volume of cervix removed and does not seem to be associated with a single treatment. For women who are at high risk it advised they receive cervical length scans during their pregnancy and they may benefit from a cervical suture.
Loop excision of cervix is a very effective treatment for removing pre-cancer of the cervix with 98% of women having no residual abnormal cells after treatment. 2% of women will have persistent or recurrent disease after treatment. You will require a cervical smear test six months after the treatment to make sure there are no abnormal cells left and your doctor will arrange this for you.
