LLETZ stands for “Large Loop Excision of the Transformation Zone”. The LLETZ procedure is a procedure commonly used to treat and remove abnormalities of the cervix detected by abnormal Pap smears, and subsequently confirmed on colposcopy. The “Transformation Zone” refers to the part of the cervix commonly affected by pre-cancerous changes, and this is the area of the cervix from which cervical cancer often originates.
Who should have a LLETZ Procedure?
Women who have high grade pre-cancerous abnormalities of the cervix (CIN 2 or CIN 3) may be advised to have a LLETZ procedure. The LLETZ procedure will remove all the abnormal cells and prevent further progression of the CIN 2/3 to become cervical cancer.
How is a LLETZ Procedure performed?
A LLETZ Procedure can be performed under a general anaesthetic or under a local anaesthetic. A colposcopy is again performed at the time, in order to confirm and define the extent of the abnormality. A wire loop is used to perform the LLETZ procedure, and an electrical current is passed through the wire loop, which allows it to precisely cut out the abnormal area on the cervix. The loop wire is very fine and thin, which allows a precise excision of tissue, and minimises any damage to the surrounding tissues. Cutting with the electrical loop also minimises the amount of bleeding from the cervical tissues, as the surrounding blood vessels are sealed off at the same time the tissues are being cut.
What are the risks of having a LLETZ Procedure?
The LLETZ procedure is generally very safe and complication rates are low, but any medical procedure involves an inherent risk. The possible risks include:
- Bleeding. This may occur at the time of surgery, or in the first couple of weeks after surgery.
- Infection. This may require treatment with antibiotics.
- Further surgery may be required if not all of the abnormal cells are removed completely.
- Although uncommon, some studies have shown an increase in future pregnancy risk with late miscarriage or preterm delivery, because the cervix may be weakened by the LLETZ procedure. The risk increases if you require more than one LLETZ procedure.
- Very rarely, there may be narrowing or scarring of the cervical canal. This may result in painful periods, difficulty in performing adequate pap smears, or problems in the progress of labour in subsequent pregnancies.
What may I expect after the LLETZ Procedure?
Dr Amy Tang will perform your LLETZ procedure as a “day procedure” either at The Wesley Hospital or Greenslopes Private Hospital. After a brief period of observation in recovery, you will be discharged home on the same day. You will need to arrange a friend or relative to drive you home.
Some period-like pain will be experienced by most women after the LLETZ procedure. This is usually relieved with simple pain killers, such as paracetamol or anti-inflammatories (e.g. Ibuprofen).
It is normal to have a bloody vaginal discharge for several days after the LLETZ procedure. This should settle within 1-2 weeks. If you experience increased bleeding that is a lot heavier than your usual period, then please contact Dr Amy Tang for advice. After the initial 1-2 weeks of bloody discharge, a clear discharge may persist for up to 6 weeks.
Most women are able to return to work the following day after a LLETZ procedure, but some women may require more time off work, depending on their recovery and the nature of their work.
You should avoid sexual intercourse for 4 weeks after your LLETZ procedure.
What follow-up do I need after the LLETZ Procedure?
A follow-up consultation with Dr Amy Tang is very important after the LLETZ procedure. A colposcopy and Pap smear is performed 6 months after the LLETZ procedure, in order to check that all of the abnormal cells have been removed.
Dr Amy Tang is a female gynaecological oncologist who has a special interest in colposcopy and early detection and treatment of pre-cancerous changes of the cervix, as well as being a sub-specialist gynaecological oncologist experienced in the treatment of cervical cancers. She is a Brisbane colposcopy specialist with full accreditation as a colposcopist for diagnosis and treatment of cervical abnormalities.