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What is loop excision and why do I need one?

What Is Loop Excision? Why Do I Need One

June is home to Cervical Screening Awareness week and it’s a time to talk about life-saving testing and treatment that people often feel embarrassed to discuss. Around 1 in 20 women will receive an abnormal smear test result. And if you’ve been told you may need loop excision, it’s normal to feel worried – but the process is very routine and has excellent success rates. Let’s break it down.

So what is the vaginal microbiome, why does it matter, and how can you best look after it? Let’s break it down.

What is loop excision?

Your regular cervical ‘smear’ test may discover abnormal cells in your cervix. These cells may be pre-cancerous or cancer in its very early stage. If this is the case, doctors most often employ a procedure called loop excision – also referred to as large loop excision of the transformation zone (LLETZ) or loop electrosurgical excision procedure (LEEP). A loop excision procedure serves to eliminate abnormal cells in the cervix, diagnose cervical cancer if it is present, and treat early-stage cervical cancer. Loop excision is successful in more than 90% of cases.

Loop excision is a procedure in which a thin wire loop is employed to remove the abnormal cervical cells. This wire loop is heated by an electrical current so that it can both remove the cells and cauterise the wound at the same time.

Why do I need a loop excision? Should I be worried if I need a LEEP?

You will have been asked to undergo a loop excision because your cervical screening (‘smear test’) has discovered abnormal cervical (‘pre-cancerous’) cells or cervical cancer in very early stage. At this point, loop excision is almost always an effective treatment to deal with the issue.

Dr Alex Eskander, Consultant Gynaecologist at The Gynae Centre says: “It is understandable if you feel alarmed by the prospect of undergoing loop excision but keep in mind that it is a very routine procedure that is successful in over 90% of cases. The overwhelming majority of women who have loop excision will be absolutely fine and have no need for further treatment. However, if you leave them untreated, these abnormal cells could develop into cervical cancer. So if you have been told you require loop excision, don’t ignore the problem and don’t delay.”

What happens in a loop excision?

Loop excision is a very routine outpatient procedure and you usually won’t be in the clinic for longer than an hour.

You will be asked to undress below the waist and lie on your back with your legs in adjustable leg rests and you will be given a cover sheet for comfort. Your gynaecologist will carefully ease a clean speculum into your vagina to keep it open. Speculums come in various sizes so you can request a smaller option if you experience any discomfort. If for any reason you find this distressing, our team is experienced in offering adjustments, comfort and reassurance – and of course you do not need to explain why.

You may feel a bit uncomfortable when your cervix is injected with local anaesthetic, but this will quickly numb the region so you don’t feel anything as the loop excision is carried out. Most women have loop excision under local anaesthetic. However for a variety of reasons, some women choose to sedated.

When the area is numb, the doctor will use the heated wire loop to extract the abnormal or cancerous cells. It is not uncommon to note a burning smell and a bit of pressure in the cervix at this point but this is nothing to worry about.

After that, the speculum will be removed and your clinician will give you privacy to get dressed again. You should bring a sanitary pad with you because you might have some minor bleeding following the LLETZ.

LLETZ is usually completed in around 15 minutes.

Loop excision aftercare

After the tissue is removed it is sent to a lab for analysis, to establish the grade of abnormality and to confirm that all the abnormal cells have been extracted. Lab results normally take from 2 to 4 weeks to come back.

You may experience bleeding for around 4 weeks after a loop excision, and discharge is fairly common too. During this time of healing, take these measures to help avoid an infection:

  • Do not use tampons or menstrual cups
  • Don’t have sexual intercourse
  • Avoid strenuous exercise that creates sweating
  • Don’t go swimming
  • No leisurely soaks in the bath.

If the bleeding is heavier than a normal period for you, or it goes on past 4 weeks, get in touch with your healthcare professional.

Are there any risks or side effects with a loop excision?

Aside from bleeding, some women experience a few other side effects after a loop excision, including:

  • Cramps (similar to period pains)
  • Unusual vaginal discharge
  • Greater levels of fatigue during your period
  • Pelvic discomfort
  • Early menstruation
  • Discomfort or bleeding during and after sexual intercourse (and remember you should not have sex during the post-procedure bleeding period).

Most people that have loop excision will be absolutely fine. However every medical procedure carries some risks, and loop excision is no exception. These include:

  • Cervical narrowing, closing, or scarring
  • Slightly higher risk of late miscarriage or premature labour
  • Cervical stenosis (this is when the spinal canal is too narrow for the nerve roots and spinal cord) which can cause problems like pain and numbness.
  • Infection

Yellow vaginal discharge is common after LLETZ for 3-4 weeks.

If you are taking any blood-thinning medicines or if you have a haematological disorder, you must inform your doctor before loop excision.

Here at The Gynae Centre, our standards of care are second to none. Cervical screening, colposcopy and loop excision procedures are all delivered by consultant gynaecologists with state of the art equipment.

As routine as loop excision is, we know how anxiety-inducing it can be for women, and we do everything we can to make the procedure as quick and reassuring as possible. With this in mind, we can often offer same day appointments, to get things resolved swiftly.

For peace of mind, book a consultation or call 020 7580 8090.