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Introduction ⬇

A loop electrosurgical excision procedure (LEEP) and cervical conization, also known as a cone biopsy, are procedures that may be performed as a follow-up for an abnormal Pap smear and colposcopy findings, to enhance accuracy of colposcopy, and to investigate squamous intraepithelial lesions. They are done to exclude invasive cancer, determine extent of noninvasive lesions, and treat and remove abnormal cervical dysplasia, based on lesion size, distribution, and grade, when there is lack of correlation between Pap smear, previous biopsy, and colposcopy.

Procedure ⬆ ⬇

  1. Place the patient's feet in stirrups and insert a speculum, as with a Pap test and colposcopy.

  2. Apply a local anesthetic to the cervix and a mild vinegar (acetic acid) or iodine, depending on the procedure type. For LEEP procedures, a grounding pad is placed on or under the patient's thigh and a fine wire loop with a special high-frequency current is used to remove a small piece of cervical tissue. A cone-shaped piece of cervical tissue is removed during a cervical conization.

  3. Apply a paste to the cervix to reduce bleeding. This may cause a dark vaginal discharge.

Clinical Alert

Complications may include heavy bleeding, severe cramping, infection, and unintentional cutting or burning of normal tissue. Cervical stenosis may be an untoward effect of this procedure.

Clinical Implications ⬆ ⬇

Abnormal findings include dysplasia and invasive cancer into deeper parts of the cervix.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain purpose, procedure, and equipment used.

  2. Provide support and take measures to relieve fear and anxiety about possible diagnosis of cervical cancer.

  3. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Instruct patient to call healthcare provider if heavy or bright-red bleeding or clots, chills, aching, severe abdominal pain (not relieved by pain medication), foul-smelling discharge, or unusual swelling occurs.

  2. Explain to the patient that watery discharge and white, dark, and light spotting may last approximately 4 weeks with the heaviest discharge occurring for about 1 week after treatment. Tell the patient to not use tampons.

  3. Tell the patient to not use tampons, to avoid douching or bubble baths, and to delay sexual intercourse for approximately 4 weeks.

  4. Be sure to stress the importance of returning for follow-up appointment to evaluate satisfactory healing.

  5. Follow Chapter 1 guidelines for safe, effective, informed posttest care.

Reference Values ⬆

Normal