Loop diathermy excision of the cervix (LLETZ)

What is loop diathermy excision?

A small wire loop is used to remove an area of the cervix containing the abnormal cells. It is most commonly performed using local anaesthetic and the whole procedure takes about 10 minutes. Loop diathermy excision is sometimes referred to as a LLETZ.

Benefits of treatment

LLETZ is 90–95% effective in removing all the abnormal cells. However, it is important to have regular follow-up smear tests to confirm this. If the abnormal cells are not removed there is a small chance that they may develop into cancer in the future.

What can I expect afterwards?

You may experience some or none of the following:

  • Some discomfort similar to period pain for the next few hours. You can take mild painkillers for this and you may wish to take some prior to the treatment.
  • Some bleeding or discharge. You may also see black particles which is normal and is caused by the diathermy used during the treatment. Initially the bleeding is often like a heavy period before changing to a pink, then brown discharge. It may last for up to a month.
  • Your next period may arrive earlier and be heavier than normal. Your periods will then return to normal.

Everyone is different and heals differently, and some women will experience discharge for longer than others. The cervix needs time to heal.

Reducing the risk of bleeding or infection

To reduce the risk of bleeding or infection after the treatment it is important that you:

  • Use sanitary pads and not tampons for four weeks after the treatment.
  • Do not have sexual intercourse for four weeks.
  • Do not do any vigorous exercise (including swimming) for at least two weeks.

Other considerations

  • You may drink alcohol in moderation following the treatment.
  • You may drive following the treatment, unless otherwise advised by your colposcopist (you may not be able to drive if you have had the treatment under a general anaesthetic).
  • Although there are no health grounds for avoiding overseas travel following treatment, medical attention for complications arising from the treatment may not be covered by insurance so we recommend that you do not travel for four weeks following the treatment.

Practical advice

  • Rest for the afternoon and evening following your treatment.
  • Shower as normal. It may be best to avoid baths for four weeks following the treatment.

Occasionally patients feel a little faint following the treatment so it is advisable to bring someone with you who can travel home with you. Please ensure that you have had breakfast or lunch prior to your appointment.

Risks of treatment

  • Bleeding and infection: Very small risk if you follow the recommendations above.
  • Labour and delivery: Cervical stenosis (tightness of the neck of the womb) occurs with the risk of the cervix failing to open in labour. In these cases a caesarean section is performed. The risk of this occurring is 1%.
  • Pregnancy related: There is no effect on fertility (the ability to conceive). LLETZ has been shown to be associated with a small increased risk of early delivery of babies. However, this small risk is outweighed by the benefits of removing the abnormal cells from your cervix which, if left untreated, are at risk of developing into cancer in the future. The more treatments that are required the greater the risk of early labour but most women only require one treatment.

How will I know if something is wrong?

There is a small risk of heavy bleeding (for example soaking through a sanitary towel every hour) which normally occurs within two weeks of the treatment. If this happens you will need to visit your nearest A&E department or call the colposcopy clinic for advice. If you experience any ongoing painful period cramps

and/or smelly vaginal discharge, you should contact us for advice or visit your GP or practice nurse.

What results do I receive after the treatment?

The sample removed will be sent to the laboratory for analysis. The laboratory checks that all the abnormal cells have been removed and will confirm the grade of abnormality.

What do my abnormal results mean?

CIN stands for cervical intraepithelial neoplasia. This is a term used to refer to pre-cancer cell changes and there are three grades:

  • CIN 1: This means that a third of the cells in the area are abnormal.
  • CIN 2: This means that up to two thirds of the cells in the area are abnormal.
  • CIN 3: This means that all the cells in the area are abnormal.

When will the result be available?

In approximately 4–6 weeks. Very occasionally your result may be delayed due to further analysis being required. Your results letter will be sent to your home address and also to your GP. It is important that we have your correct address and telephone number and your correct GP details. Please inform us of any changes. If you do not receive your results please contact the colposcopy clinic.

Contact information

Chelsea and Westminster Hospital

Colposcopy Clinic
Gynaecology Outpatients
1st Floor, Lift Bank B

T: 020 3315 5927
E: caw-tr.directreferral@nhs.net

West Middlesex University Hospital

Colposcopy Clinic
Queen Mary’s Building
1st Floor, Women’s Day Unit

T: 020 8321 5067
E:

Contributors
Liz Alden George Vasilopoulos ruby