What are complications of the LEEP procedure?
Bleeding is the main complication of a LEEP (loop electrical excision procedure) procedure. It happens about 4% of the time (2) but serious bleeding requiring prolonged observation, stitches or even blood transfusion are in the range of 1.5% (3).
Infection can occur following LEEP but it seems to occur less than 5% of the time and even less if prophylactic antibiotics are given.
The squamocolumnar junction of the skin of the cervix is the area where dysplasia is most likely to recur. Its position is often changed to where it cannot be visualized with colposcopy when any type of conization procedure is done.
With LEEP this may be as high as 20% of the time (4). It does not usually affect subsequent Pap smears but it can make a next colposcopy difficult.
What kind of follow-up will I have after a LEEP procedure?
Immediate Pap smears have a moderate amount of artifact so they are not usually performed (5). The first Pap smear is performed at about 3-4 months after the LEEP procedure.
The procedure itself is over 95% effective at removing all the abnormal tissue but the success rate of a LEEP at totally eradicating an abnormal Pap smear is estimated to be about 75-85% especially in the face of moderate or severe dysplasia.
This discrepancy is because most dysplasia is felt to be due to the human papilloma virus (HPV) and the virus is still present in cells around the area that was removed with the LEEP. HPV may reinfect the new cells and the dysplasia recurs with return of an abnormal Pap.
Pap smears are repeated until they return to normal and there are 3 consecutive negative smears. Then you just go back to having Pap smears on a routine yearly basis. In the alternative, if the Pap reverts to a high grade lesion (HGSIL), then another colposcopy and biopsy is performed and the process starts over again.
If you have ever had a Pap smear classified as HGSIL or had a biopsy of the cervix with moderate or severe dysplasia, or carcinoma insitu, then you should continue to have an annual Pap smear even if you end up having a hysterectomy later.
What are complications of the LEEP procedure?
Bleeding is the main complication of a LEEP procedure. It happens about 4% of the time (2) but serious bleeding requiring prolonged observation, stitches or even blood transfusion are in the range of 1.5% (3).
Infection can occur following LEEP but it seems to occur less than 5% of the time and even less if prophylactic antibiotics are given.
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